Provider Demographics
NPI:1487861027
Name:DOUGLAS B. CAMPBELL DDS, PC
Entity Type:Organization
Organization Name:DOUGLAS B. CAMPBELL DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:847-234-4800
Mailing Address - Street 1:825 S WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2696
Mailing Address - Country:US
Mailing Address - Phone:847-234-4800
Mailing Address - Fax:847-234-4876
Practice Address - Street 1:825 S WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2696
Practice Address - Country:US
Practice Address - Phone:847-234-4800
Practice Address - Fax:847-234-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty