Provider Demographics
NPI:1902285620
Name:MICHAEL P CAMPEAU, DDS, PC
Entity Type:Organization
Organization Name:MICHAEL P CAMPEAU, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CAMPEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-924-2320
Mailing Address - Street 1:661 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-9708
Mailing Address - Country:US
Mailing Address - Phone:231-924-2320
Mailing Address - Fax:231-924-1518
Practice Address - Street 1:661 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-9708
Practice Address - Country:US
Practice Address - Phone:231-924-2320
Practice Address - Fax:231-924-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018633261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental