Provider Demographics
NPI:1295728798
Name:CAMPBELL, DONOVAN C (DDS)
Entity type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:C
Last Name:CAMPBELL
Suffix:
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 1:24 W MAIN ST
Mailing Address - Street 2:PO BOX 535
Mailing Address - City:MC CONNELSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43756-1215
Mailing Address - Country:US
Mailing Address - Phone:740-962-6122
Mailing Address - Fax:740-962-2095
Practice Address - Street 1:24 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MC CONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-1215
Practice Address - Country:US
Practice Address - Phone:740-962-6122
Practice Address - Fax:740-962-2095
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0807390Medicaid