Provider Demographics
NPI:1457499162
Name:CAMPISI, JEFFREY P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:CAMPISI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6302 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2026
Mailing Address - Country:US
Mailing Address - Phone:631-929-1234
Mailing Address - Fax:631-929-4550
Practice Address - Street 1:6336 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2030
Practice Address - Country:US
Practice Address - Phone:631-929-1234
Practice Address - Fax:631-929-4550
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0493901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry