Provider Demographics
NPI:1720218720
Name:CAMPAGNA, ALEXANDER NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:NICHOLAS
Last Name:CAMPAGNA
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 1:36 THOMAS INDIAN SCHOOL DRIVE
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:NY
Mailing Address - Zip Code:14081-9300
Mailing Address - Country:US
Mailing Address - Phone:716-532-0165
Mailing Address - Fax:716-242-6344
Practice Address - Street 1:36 THOMAS INDIAN SCHOOL DRIVE
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9300
Practice Address - Country:US
Practice Address - Phone:716-532-0165
Practice Address - Fax:716-242-6344
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP69806122300000X
NY054925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist