Provider Demographics
NPI:1861420820
Name:CAMPBELL, LEE GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:GEORGE
Last Name:CAMPBELL
Suffix:
Gender:M
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:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39121-0945
Mailing Address - Country:US
Mailing Address - Phone:601-442-4459
Mailing Address - Fax:601-442-0534
Practice Address - Street 1:224 DEVEREAUX DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3752
Practice Address - Country:US
Practice Address - Phone:601-442-4459
Practice Address - Fax:601-442-0534
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS160074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00064035Medicaid