Provider Demographics
NPI:1538373329
Name:CAMPO, GERALD JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:JOSEPH
Last Name:CAMPO
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13611 100TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5234
Mailing Address - Country:US
Mailing Address - Phone:425-821-3388
Mailing Address - Fax:425-825-3840
Practice Address - Street 1:13611 100TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5234
Practice Address - Country:US
Practice Address - Phone:425-821-3388
Practice Address - Fax:425-825-3840
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA835870OtherUNITED CONCORDIA
WA5030416Medicaid
WACA7085OtherREGENCE BLUE SHIELD
WA40231OtherL&I