Healthcare Provider Details

I. General information

NPI: 1093334443
Provider Name (Legal Business Name): CONOR CAMPBELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 SILVERSIDE RD STE 12
WILMINGTON DE
19810-4913
US

IV. Provider business mailing address

3512 SILVERSIDE RD STE 12
WILMINGTON DE
19810-4913
US

V. Phone/Fax

Practice location:
  • Phone: 845-649-8717
  • Fax:
Mailing address:
  • Phone: 302-477-1800
  • Fax: 302-477-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberG1-0011568
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: