Provider Demographics
NPI:1396909354
Name:CAMPBELL DENTAL P.A.
Entity type:Organization
Organization Name:CAMPBELL DENTAL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:HANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-407-9401
Mailing Address - Street 1:6090 CAMPBELL RD
Mailing Address - Street 2:STE# 114
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:972-407-9401
Mailing Address - Fax:972-407-9466
Practice Address - Street 1:6090 CAMPBELL RD
Practice Address - Street 2:STE# 114
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1223
Practice Address - Country:US
Practice Address - Phone:972-407-9401
Practice Address - Fax:972-407-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty