Provider Demographics
NPI:1518063601
Name:CAMPEAU, RICHARD HARVEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HARVEY
Last Name:CAMPEAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17040 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4421
Mailing Address - Country:US
Mailing Address - Phone:248-349-7898
Mailing Address - Fax:
Practice Address - Street 1:26776 W 12 MILE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7807
Practice Address - Country:US
Practice Address - Phone:248-355-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI102111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice