Provider Demographics
NPI:1740552066
Name:CAMPANELLA, THOMAS ANDO (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANDO
Last Name:CAMPANELLA
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 1:907 N NEW WARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-4250
Mailing Address - Country:US
Mailing Address - Phone:850-453-2359
Mailing Address - Fax:850-453-2350
Practice Address - Street 1:907 N NEW WARRINGTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-4250
Practice Address - Country:US
Practice Address - Phone:850-453-2359
Practice Address - Fax:850-453-2350
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN72161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice