MEDICARE: DR. ROBERT LEE 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401005145	VA

General Provider Information

NPI Number	:	1760529358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LEE CAMPBELL DDS

Provider Business Mailing Address
First Line	:	11551 NUCKOLS RD SUITE A
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059
Country	:	US
Telephone Number	:	804-273-6818
Fax Number	:	804-273-0359

Provider Business Practice Location Address
First Line	:	11551 NUCKOLS RD STE A
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5565
Country	:	US
Telephone Number	:	804-273-6818
Fax Number	:	804-273-0359

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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