MEDICARE: DR. SUZANNE YVONNE CAMPBELL DDS

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	122300000X	Dentist	DS038625	PA
2	122300000X	Dentist	055491	NY

General Provider Information

NPI Number	:	1669768057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE YVONNE CAMPBELL DDS

Provider Business Mailing Address
First Line	:	359 GIBSON HILL RD
Second Line	:
City	:	CHESTER
State	:	NY
Zip	:	10918-2321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 GIBSON HILL RD
Second Line	:
City	:	CHESTER
State	:	NY
Zip	:	10918-2321
Country	:	US
Telephone Number	:	845-572-3463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	07/19/2011

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