Provider Demographics
NPI:1003079500
Name:CAMPBELL, AARON GLENN (DDS)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:GLENN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W PORT PLZ STE 367
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3124
Mailing Address - Country:US
Mailing Address - Phone:314-434-4676
Mailing Address - Fax:314-434-6806
Practice Address - Street 1:77 W PORT PLZ STE 367
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3124
Practice Address - Country:US
Practice Address - Phone:314-434-4676
Practice Address - Fax:314-434-6806
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008015942122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist