Provider Demographics
NPI:1295226967
Name:CAMPBELL, CASSANDRA CLARK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:CLARK
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 PALATINE CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0176
Mailing Address - Country:US
Mailing Address - Phone:530-515-8502
Mailing Address - Fax:
Practice Address - Street 1:4902 GOLDEN QUAIL STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1637
Practice Address - Country:US
Practice Address - Phone:210-690-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics