Provider Demographics
NPI:1447678008
Name:JAMES A. CAMPO, DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:JAMES A. CAMPO, DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DESROCHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-866-0681
Mailing Address - Street 1:2215 S CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-2952
Mailing Address - Country:US
Mailing Address - Phone:504-866-0681
Mailing Address - Fax:504-866-6063
Practice Address - Street 1:2215 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-2952
Practice Address - Country:US
Practice Address - Phone:504-866-0681
Practice Address - Fax:504-866-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty