Provider Demographics
NPI:1104659036
Name:CAMPIONE, KATY LEANNE (RDH)
Entity type:Individual
Prefix:MRS
First Name:KATY
Middle Name:LEANNE
Last Name:CAMPIONE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 HEARTLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-8438
Mailing Address - Country:US
Mailing Address - Phone:616-319-3678
Mailing Address - Fax:
Practice Address - Street 1:2542 HEARTLAND BLVD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-8438
Practice Address - Country:US
Practice Address - Phone:616-319-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902015581124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist