Provider Demographics
NPI:1649591637
Name:CAMPBELL, AARON LYLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:LYLE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-4931
Mailing Address - Country:US
Mailing Address - Phone:614-204-3361
Mailing Address - Fax:
Practice Address - Street 1:2045 LEE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1836
Practice Address - Country:US
Practice Address - Phone:407-629-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN191991223S0112X, 1223P0106X
FLD191991223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Single Specialty