Provider Demographics
NPI:1689808164
Name:CAMPBELL, LAURIE TEDDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:TEDDER
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LAURIE
Other - Middle Name:MICHELLE
Other - Last Name:TEDDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:7820 BALLANTYNE COMMONS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2889
Mailing Address - Country:US
Mailing Address - Phone:704-759-0000
Mailing Address - Fax:704-759-9937
Practice Address - Street 1:7820 BALLANTYNE COMMONS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2889
Practice Address - Country:US
Practice Address - Phone:704-759-0000
Practice Address - Fax:704-759-9937
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry