Provider Demographics
NPI:1558573212
Name:CAMPBELL, AMY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 CARIBOU DR W
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8570
Mailing Address - Country:US
Mailing Address - Phone:215-280-1760
Mailing Address - Fax:
Practice Address - Street 1:1055 E STEWART AVE BLDG 2018
Practice Address - Street 2:
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-2900
Practice Address - Country:US
Practice Address - Phone:719-556-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278541223P0300X
PADS0369311223P0300X
CODEN.002045341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics