Provider Demographics
NPI:1902941206
Name:CAMPBELL, BERNICE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BERNICE
Middle Name:
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 1:8013 NEW LAGRANGE RD
Mailing Address - Street 2:STE 3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222
Mailing Address - Country:US
Mailing Address - Phone:502-426-1047
Mailing Address - Fax:502-426-1059
Practice Address - Street 1:8013 NEW LAGRANGE RD
Practice Address - Street 2:STE 3
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-426-1047
Practice Address - Fax:502-426-1059
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist