Provider Demographics
NPI:1982250759
Name:CAMPBELL, NATALIE MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:HALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:146 CLARK ROAD, BLDG 339
Mailing Address - Street 2:
Mailing Address - City:FORT SHAFTER
Mailing Address - State:HI
Mailing Address - Zip Code:96858
Mailing Address - Country:US
Mailing Address - Phone:808-438-5555
Mailing Address - Fax:
Practice Address - Street 1:146 CLARK ROAD, BLDG 339
Practice Address - Street 2:
Practice Address - City:FORT SHAFTER
Practice Address - State:HI
Practice Address - Zip Code:96858
Practice Address - Country:US
Practice Address - Phone:808-438-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002024165124Q00000X
GADH043290124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist