Provider Demographics
NPI:1750448080
Name:CAMPAGNA, EUGENE DONALD JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:DONALD
Last Name:CAMPAGNA
Suffix:JR
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 1:241 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1518
Mailing Address - Country:US
Mailing Address - Phone:724-458-8770
Mailing Address - Fax:724-458-1605
Practice Address - Street 1:241 W PINE ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1518
Practice Address - Country:US
Practice Address - Phone:724-458-8770
Practice Address - Fax:724-458-1605
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022937L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice