Healthcare Provider Details

I. General information

NPI: 1619564606
Provider Name (Legal Business Name): RINA CAMPBELL DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2020
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 MOWRY AVE, SUITE A5
FREMONT CA
94538
US

IV. Provider business mailing address

4580 MEYER PARK CIRCLE
FREMONT CA
94536
US

V. Phone/Fax

Practice location:
  • Phone: 510-882-7341
  • Fax: 510-675-7466
Mailing address:
  • Phone: 510-520-6326
  • Fax: 510-675-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. RINA CAMPBELL
Title or Position: PRESIDENT
Credential: DMD
Phone: 501-882-7341