Provider Demographics
NPI:1235214743
Name:CAMPBELL, GALE CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GALE
Middle Name:CHARLES
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 1:103 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1842
Mailing Address - Country:US
Mailing Address - Phone:509-754-5236
Mailing Address - Fax:509-754-3248
Practice Address - Street 1:103 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1842
Practice Address - Country:US
Practice Address - Phone:509-754-5236
Practice Address - Fax:509-754-3248
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA42761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3568OtherWASHINGTON DENTAL SERVICE
WA949-72OtherDEPT OF LABOR & INDUSTRY
WA979825OtherUNITED CONCORDIA INSURANC