Provider Demographics
NPI:1871932681
Name:CAMPBELL, JEFFREY DALLAS (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DALLAS
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2380
Mailing Address - Country:US
Mailing Address - Phone:507-372-7339
Mailing Address - Fax:507-372-7330
Practice Address - Street 1:1027 2ND AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2380
Practice Address - Country:US
Practice Address - Phone:507-372-7339
Practice Address - Fax:507-372-7330
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist