Provider Demographics
NPI:1871696245
Name:CAMPAGNA, PHILIP L JR (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:CAMPAGNA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WOODLAND CT
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360
Mailing Address - Country:US
Mailing Address - Phone:219-872-0519
Mailing Address - Fax:219-872-0521
Practice Address - Street 1:106 WOODLAND CT
Practice Address - Street 2:SUITE 3
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-872-0519
Practice Address - Fax:219-872-0521
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007436A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist