Provider Demographics
NPI:1447274170
Name:CAMPBELL, ROBERT L JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25015-1610
Mailing Address - Country:US
Mailing Address - Phone:304-949-2672
Mailing Address - Fax:
Practice Address - Street 1:424 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:BELLE
Practice Address - State:WV
Practice Address - Zip Code:25015-1610
Practice Address - Country:US
Practice Address - Phone:304-949-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV25181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0136476000Medicaid