Provider Demographics
NPI:1730118043
Name:CAMPBELL, DAVID ALEX (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALEX
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 1:5207 HIGHLANDS LAKEVIEW LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-5059
Mailing Address - Country:US
Mailing Address - Phone:863-607-4979
Mailing Address - Fax:
Practice Address - Street 1:3003 S FLORIDA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4050
Practice Address - Country:US
Practice Address - Phone:863-687-9227
Practice Address - Fax:863-687-2813
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN142691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics