Provider Demographics
NPI:1538229992
Name:CAMPBELL-LEACH, EVELYN T (DDS)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:T
Last Name:CAMPBELL-LEACH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4918
Mailing Address - Country:US
Mailing Address - Phone:301-265-1650
Mailing Address - Fax:301-248-6509
Practice Address - Street 1:9500 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4918
Practice Address - Country:US
Practice Address - Phone:301-265-1650
Practice Address - Fax:301-248-6509
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD09266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist