Provider Demographics
NPI:1003331299
Name:CAMPBELL, MATTHEW S (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SICKLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2205
Mailing Address - Country:US
Mailing Address - Phone:845-535-9548
Mailing Address - Fax:
Practice Address - Street 1:2 SICKLETOWN RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2205
Practice Address - Country:US
Practice Address - Phone:845-535-9548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0403461223X0400X
NJ22DI028563001223X0400X
NJ22DI028563011223X0400X
NY0594281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics