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NPI Code Detail

MEDICARE: DR. HEATHER CAMPBELL

MEDICARE: DR. HEATHER CAMPBELL
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
11223G0001XGeneral Practice Dentistry4690WI

General Provider Information

NPI Number : 1639235377
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HEATHER CAMPBELL
Provider Business Mailing Address
First Line : 2555 N MARTIN LUTHER KING DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-2709
Country : US
Telephone Number : 414-760-7200
Fax Number : 414-760-3987
Provider Business Practice Location Address
First Line : 8200 W SILVER SPRING DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53218-2552
Country : US
Telephone Number : 414-760-7200
Fax Number : 414-760-3987
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2006
Last Update Date : 12/11/2012

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Directions to “ DR. HEATHER CAMPBELL ” Practice Location

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