Provider Demographics
NPI:1326113184
Name:CAMPBELL, MICHAEL AXTON (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AXTON
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:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:KEYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23947-0108
Mailing Address - Country:US
Mailing Address - Phone:434-736-8748
Mailing Address - Fax:434-736-8419
Practice Address - Street 1:126 J STREET
Practice Address - Street 2:
Practice Address - City:KEYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23947
Practice Address - Country:US
Practice Address - Phone:434-736-8748
Practice Address - Fax:434-736-8419
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010066541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice