Provider Demographics
NPI:1912904871
Name:CAMPBELL, ANN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9492 DOUBLE R BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5977
Mailing Address - Country:US
Mailing Address - Phone:775-853-1999
Mailing Address - Fax:775-852-1935
Practice Address - Street 1:9492 DOUBLE R BLVD STE A
Practice Address - Street 2:STE. A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4820
Practice Address - Country:US
Practice Address - Phone:775-853-1999
Practice Address - Fax:775-852-1935
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4420122300000X
CA48433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4420TOtherLICENSE # JUNE03-JUNE05
CA48433OtherLICENSE NUMBER
NV4420OtherLICENSE #JULY05-PRESENT
NV4420OtherLICENSE #JULY05-PRESENT