Provider Demographics
NPI:1356440200
Name:CAMPBELL, AMY L (DMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 COMMERCIAL ST
Mailing Address - Street 2:GLEN COVE DENTAL ASSOCIATES, PA
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-3801
Mailing Address - Country:US
Mailing Address - Phone:207-594-5500
Mailing Address - Fax:207-596-6349
Practice Address - Street 1:1060 COMMERCIAL ST
Practice Address - Street 2:GLEN COVE DENTAL ASSOCIATES, PA
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-3801
Practice Address - Country:US
Practice Address - Phone:207-594-5500
Practice Address - Fax:207-596-6349
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BC8810649OtherDEA