Provider Demographics
NPI:1508863523
Name:CAMPBELL, DOUGLAS L (DDS, MS, PC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N KENDRICK ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1586
Mailing Address - Country:US
Mailing Address - Phone:928-774-2238
Mailing Address - Fax:
Practice Address - Street 1:750 N KENDRICK ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1586
Practice Address - Country:US
Practice Address - Phone:928-774-2238
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD49341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry