Provider Demographics
NPI:1750475398
Name:CAMPBELL, DEIRDRE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4447 CAMINO REAL WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966
Mailing Address - Country:US
Mailing Address - Phone:239-936-7400
Mailing Address - Fax:
Practice Address - Street 1:4447 CAMINO REAL WAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966
Practice Address - Country:US
Practice Address - Phone:239-936-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN165331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice