Provider Demographics
NPI:1568103000
Name:MCCAMPBELL, JENNIFER MCMAHAN (RDH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MCMAHAN
Last Name:MCCAMPBELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8762 HOLLINGSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-9429
Mailing Address - Country:US
Mailing Address - Phone:865-919-5918
Mailing Address - Fax:
Practice Address - Street 1:6311 KINGSTON PIKE STE 8W
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4906
Practice Address - Country:US
Practice Address - Phone:865-584-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2726124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty