Healthcare Provider Details

I. General information

NPI: 1699812982
Provider Name (Legal Business Name): JEFFREY RICHARD CAMPBELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 CENTRAL PARK BLVD SUITE 201
FREDERICKSBURG VA
22401-4932
US

IV. Provider business mailing address

1420 CENTRAL PARK BLVD SUITE 201
FREDERICKSBURG VA
22401-4932
US

V. Phone/Fax

Practice location:
  • Phone: 540-786-0696
  • Fax: 540-785-1340
Mailing address:
  • Phone: 540-786-0696
  • Fax: 540-785-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number0401008862
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401008862
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: