Healthcare Provider Details

I. General information

NPI: 1760529358
Provider Name (Legal Business Name): ROBERT LEE CAMPBELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11551 NUCKOLS RD STE A
GLEN ALLEN VA
23059-5565
US

IV. Provider business mailing address

11551 NUCKOLS RD SUITE A
GLEN ALLEN VA
23059
US

V. Phone/Fax

Practice location:
  • Phone: 804-273-6818
  • Fax: 804-273-0359
Mailing address:
  • Phone: 804-273-6818
  • Fax: 804-273-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401005145
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: