Provider Demographics
NPI:1063079127
Name:CAMPISANO, TARA MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:MICHELLE
Last Name:CAMPISANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 DURANGO GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-1381
Mailing Address - Country:US
Mailing Address - Phone:513-205-4879
Mailing Address - Fax:
Practice Address - Street 1:792 EASTGATE SOUTH DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1592
Practice Address - Country:US
Practice Address - Phone:513-746-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0257771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice