Provider Demographics
NPI:1235187600
Name:CAMPBELL, ROBERT CLYDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLYDE
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 1:102 S MAIN ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SCOTTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49454-1249
Mailing Address - Country:US
Mailing Address - Phone:231-757-4411
Mailing Address - Fax:231-757-3036
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:SUITE #2
Practice Address - City:SCOTTVILLE
Practice Address - State:MI
Practice Address - Zip Code:49454-1249
Practice Address - Country:US
Practice Address - Phone:231-757-4411
Practice Address - Fax:231-757-3036
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI74261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice