Healthcare Provider Details

I. General information

NPI: 1609619766
Provider Name (Legal Business Name): AUSTIN CAMPBELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 OLD FRANKLIN TPKE UNIT 3
ROCKY MOUNT VA
24151-5881
US

IV. Provider business mailing address

17 CAMPBELL AVE SW APT 541
ROANOKE VA
24011-1301
US

V. Phone/Fax

Practice location:
  • Phone: 540-489-8191
  • Fax:
Mailing address:
  • Phone: 856-981-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401418874
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: