Provider Demographics
NPI:1932119633
Name:CAMPBELL, ALFRED JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:JOHN
Last Name:CAMPBELL
Suffix:
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:PO BOX 100
Mailing Address - Street 2:19317 ROUTE 208
Mailing Address - City:FRYBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16326-0100
Mailing Address - Country:US
Mailing Address - Phone:814-354-7341
Mailing Address - Fax:814-354-7342
Practice Address - Street 1:19317 ROUTE 208
Practice Address - Street 2:
Practice Address - City:FRYBURG
Practice Address - State:PA
Practice Address - Zip Code:16326-0100
Practice Address - Country:US
Practice Address - Phone:814-354-7341
Practice Address - Fax:814-354-7342
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025743L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice