Provider Demographics
NPI:1487660510
Name:CAMPAGNA, THOMAS BAXTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BAXTER
Last Name:CAMPAGNA
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:PO BOX 8307
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-8307
Mailing Address - Country:US
Mailing Address - Phone:432-694-1659
Mailing Address - Fax:432-520-0720
Practice Address - Street 1:3722 N LOOP 250 W
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707
Practice Address - Country:US
Practice Address - Phone:432-694-1659
Practice Address - Fax:432-520-0720
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice