Provider Demographics
NPI:1376930867
Name:CAMPBELL, ROBERT IAN JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:IAN
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 SPRUCE PL APT 1005
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2692
Mailing Address - Country:US
Mailing Address - Phone:870-816-5691
Mailing Address - Fax:
Practice Address - Street 1:1116 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2109
Practice Address - Country:US
Practice Address - Phone:641-682-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery