Provider Demographics
NPI:1619052149
Name:CAMPBELL, ROBERT PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:PAUL
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:205 E BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4903
Mailing Address - Country:US
Mailing Address - Phone:814-237-1751
Mailing Address - Fax:814-237-6069
Practice Address - Street 1:205 E BEAVER AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4903
Practice Address - Country:US
Practice Address - Phone:814-237-1751
Practice Address - Fax:814-237-6069
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029093-L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics