Provider Demographics
NPI:1689831711
Name:CAMPBELL, ANDREW JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
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 1:2703 E STAN SCHLUETER LOOP
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542
Mailing Address - Country:US
Mailing Address - Phone:254-526-5667
Mailing Address - Fax:254-526-7200
Practice Address - Street 1:2703 E STAN SCHLUETER LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542
Practice Address - Country:US
Practice Address - Phone:254-526-5667
Practice Address - Fax:254-526-7200
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202425901Medicaid