Provider Demographics
NPI:1538223680
Name:R DOUGLAS CAMPBELL, DMD, INC
Entity type:Organization
Organization Name:R DOUGLAS CAMPBELL, DMD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-421-5500
Mailing Address - Street 1:2260 OTAY LAKES RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1005
Mailing Address - Country:US
Mailing Address - Phone:619-421-5500
Mailing Address - Fax:619-656-4320
Practice Address - Street 1:2260 OTAY LAKES RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1005
Practice Address - Country:US
Practice Address - Phone:619-421-5500
Practice Address - Fax:619-656-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty