Provider Demographics
NPI:1164900809
Name:CAMPBELL, PATRICIA MICHELLE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MICHELLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 CRANFORD AVE APT 33
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7228
Mailing Address - Country:US
Mailing Address - Phone:951-842-4559
Mailing Address - Fax:
Practice Address - Street 1:2440 RIVER RD STE 140
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2402
Practice Address - Country:US
Practice Address - Phone:951-225-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79344126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant