Provider Demographics
NPI:1598744260
Name:CAMPBELL, SCOTT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:CAMPBELL
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 1:12 LEXINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4071
Mailing Address - Country:US
Mailing Address - Phone:740-369-5309
Mailing Address - Fax:740-369-0731
Practice Address - Street 1:12 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-4071
Practice Address - Country:US
Practice Address - Phone:740-369-5309
Practice Address - Fax:740-369-0731
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH194571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice