Provider Demographics
NPI:1720786221
Name:CAMPBELL, ESSENCE ANTOINETTE (DDS)
Entity Type:Individual
Prefix:
First Name:ESSENCE
Middle Name:ANTOINETTE
Last Name:CAMPBELL
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 1:944 21ST AVE N APT 907
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3457
Mailing Address - Country:US
Mailing Address - Phone:256-213-8792
Mailing Address - Fax:
Practice Address - Street 1:944 21ST AVE N APT 907
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3457
Practice Address - Country:US
Practice Address - Phone:256-213-8792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN121251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice