MEDICARE: DR. DAVID STUART CAMPBELL D.D.S.

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	37062	CA

General Provider Information

NPI Number	:	1992703763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID STUART CAMPBELL D.D.S.

Provider Business Mailing Address
First Line	:	1955 LAKE AVE
Second Line	:
City	:	ALTADENA
State	:	CA
Zip	:	91001-3037
Country	:	US
Telephone Number	:	626-585-9544
Fax Number	:	626-449-4932

Provider Business Practice Location Address
First Line	:	1955 LAKE AVE
Second Line	:
City	:	ALTADENA
State	:	CA
Zip	:	91001-3037
Country	:	US
Telephone Number	:	626-585-9544
Fax Number	:	626-449-4932

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	10/09/2015

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