Healthcare Provider Details

I. General information

NPI: 1336137645
Provider Name (Legal Business Name): MICHAEL PETER CAMPEAU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E. MAIN ST.
FREMONT MI
49412
US

IV. Provider business mailing address

661 E. MAIN ST.
FREMONT MI
49412
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-2320
  • Fax: 231-924-1518
Mailing address:
  • Phone: 231-924-2320
  • Fax: 231-924-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901018633
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: