Provider Demographics
NPI:1336137645
Name:CAMPEAU, MICHAEL PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PETER
Last Name:CAMPEAU
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 1:661 E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412
Mailing Address - Country:US
Mailing Address - Phone:231-924-2320
Mailing Address - Fax:231-924-1518
Practice Address - Street 1:661 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412
Practice Address - Country:US
Practice Address - Phone:231-924-2320
Practice Address - Fax:231-924-1518
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
381908328OtherDENTAL HEALTH ALLIANCE
D801095OtherBLUE CROSS
381908328OtherGOLDEN DENTAL PLANS
381908328OtherGUARDIAN
88096MIOtherWADSWORTH
381908328OtherMETLIFE
88170MIOtherOUTER DRIVE
381908328020OtherDENTAL BLUE
88123MIOtherBAYSIDE
88171MIOtherCOMMERCE
O1493248OtherUNITED CONCORDIA
381908328OtherDENTEMAX
MI4527190Medicaid
88170MIOtherOUTER DRIVE
MI4527190Medicaid