Provider Demographics
NPI:1356818314
Name:CAMPBELL, KEVIN W (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:W
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 NEWTOWN RD APT 213
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5606
Mailing Address - Country:US
Mailing Address - Phone:617-879-8828
Mailing Address - Fax:
Practice Address - Street 1:PSC 851 BOX 340
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09834-0004
Practice Address - Country:US
Practice Address - Phone:319-439-6842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA04014166321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program