Provider Demographics
NPI:1891302568
Name:CAMPO, JACI RAE (DDS)
Entity Type:Individual
Prefix:
First Name:JACI
Middle Name:RAE
Last Name:CAMPO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6330
Mailing Address - Country:US
Mailing Address - Phone:325-692-1501
Mailing Address - Fax:
Practice Address - Street 1:2902 S 27TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6330
Practice Address - Country:US
Practice Address - Phone:325-692-1501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist