Provider Demographics
NPI:1285784678
Name:CAMPBELL, MELISSA DENISE (RDHAP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DENISE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 PELICAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-3988
Mailing Address - Country:US
Mailing Address - Phone:661-444-5061
Mailing Address - Fax:661-588-0102
Practice Address - Street 1:5211 PELICAN HILL DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-3988
Practice Address - Country:US
Practice Address - Phone:661-444-5061
Practice Address - Fax:661-588-0102
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist