Provider Demographics
NPI:1083894877
Name:CAMPBELL, RINA (DMD)
Entity Type:Individual
Prefix:
First Name:RINA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 GOLF LINKS ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-5605
Mailing Address - Country:US
Mailing Address - Phone:510-520-6326
Mailing Address - Fax:
Practice Address - Street 1:337 E LELAND RD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4911
Practice Address - Country:US
Practice Address - Phone:510-520-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02756449Medicaid