MEDICARE: CAMPBELL S. DELK, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401004326	VA

General Provider Information

NPI Number	:	1528356078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPBELL S. DELK, DDS, PC

Provider Business Mailing Address
First Line	:	4440 SPRINGFIELD RD
Second Line	:	SUITE 104
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-3410
Country	:	US
Telephone Number	:	804-747-9511
Fax Number	:	804-762-8930

Provider Business Practice Location Address
First Line	:	4440 SPRINGFIELD RD
Second Line	:	SUITE 104
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-3410
Country	:	US
Telephone Number	:	804-747-9511
Fax Number	:	804-762-8930

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CAMPBELL S DELK
Credential	:	DDS
Telephone Number	:	804-747-9511

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	01/05/2015

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