Provider Demographics
NPI:1811011224
Name:CAMPBELL, CLARENCE III (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:
Last Name:CAMPBELL
Suffix:III
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:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427-0035
Mailing Address - Country:US
Mailing Address - Phone:804-633-6040
Mailing Address - Fax:804-633-7061
Practice Address - Street 1:117 COURTHOUSE LANE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427-0035
Practice Address - Country:US
Practice Address - Phone:804-633-6040
Practice Address - Fax:804-633-7061
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010051281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice