Provider Demographics
NPI:1326692930
Name:CAMPBELL, MAKENSEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAKENSEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 HUNTERS CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-5453
Mailing Address - Country:US
Mailing Address - Phone:423-276-8489
Mailing Address - Fax:
Practice Address - Street 1:801 SUNSET DR # A5
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3033
Practice Address - Country:US
Practice Address - Phone:423-283-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist