Healthcare Provider Details

I. General information

NPI: 1912904871
Provider Name (Legal Business Name): ANN M CAMPBELL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9492 DOUBLE R BLVD STE A STE. A
RENO NV
89521-4820
US

IV. Provider business mailing address

9492 DOUBLE R BLVD STE. A
RENO NV
89521-5977
US

V. Phone/Fax

Practice location:
  • Phone: 775-853-1999
  • Fax: 775-852-1935
Mailing address:
  • Phone: 775-853-1999
  • Fax: 775-852-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4420
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number48433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: