Healthcare Provider Details

I. General information

NPI: 1811203698
Provider Name (Legal Business Name): NEIL CAMPBELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 MALCOLM RD STE 300
CLINTON MD
20735-1708
US

IV. Provider business mailing address

7905 MALCOLM RD STE 300
CLINTON MD
20735-1708
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-5500
  • Fax:
Mailing address:
  • Phone: 301-868-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number14975
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: