Healthcare Provider Details

I. General information

NPI: 1821149675
Provider Name (Legal Business Name): DAVID LEON CAMPBELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9310 APISON PIKE
O COLLEGEDALE TN
37315
US

IV. Provider business mailing address

9310 APISON PIKE SUITE #5
OOLTEWAH TN
37363
US

V. Phone/Fax

Practice location:
  • Phone: 423-396-3712
  • Fax: 423-531-4181
Mailing address:
  • Phone: 423-396-3712
  • Fax: 423-531-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS06837
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: