Healthcare Provider Details

I. General information

NPI: 1306394606
Provider Name (Legal Business Name): RINA CAMPBELL DMD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 DECOTO RD SUITE 6
UNION CITY CA
94587-4940
US

IV. Provider business mailing address

262 GOLF LINKS ST
PLEASANT HILL CA
94523-5605
US

V. Phone/Fax

Practice location:
  • Phone: 510-520-6326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDDS60921
License Number StateCA

VIII. Authorized Official

Name: RINA CAMPBELL
Title or Position: PRESIDENT
Credential: DMD
Phone: 510-520-6326