Healthcare Provider Details

I. General information

NPI: 1992719439
Provider Name (Legal Business Name): JEAN EILEEN CAMPBELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E YORBA LINDA BLVD STE C
PLACENTIA CA
92870-2910
US

IV. Provider business mailing address

300 E YORBA LINDA BLVD STE C
PLACENTIA CA
92870-2910
US

V. Phone/Fax

Practice location:
  • Phone: 714-528-3383
  • Fax: 714-996-0193
Mailing address:
  • Phone: 714-528-3383
  • Fax: 714-996-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD18298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: