Provider Demographics
NPI:1477689586
Name:CAMPO, JOSEPH MANUEL (DDS, APDC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MANUEL
Last Name:CAMPO
Suffix:
Gender:M
Credentials:DDS, APDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5597
Mailing Address - Country:US
Mailing Address - Phone:504-888-1617
Mailing Address - Fax:504-888-1618
Practice Address - Street 1:4141 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5597
Practice Address - Country:US
Practice Address - Phone:504-888-1617
Practice Address - Fax:504-888-1618
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice