Provider Demographics
NPI:1427157064
Name:CAMPBELL, ROBERT GREGORY (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GREGORY
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3502
Mailing Address - Country:US
Mailing Address - Phone:562-988-0148
Mailing Address - Fax:562-988-0257
Practice Address - Street 1:3960 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3502
Practice Address - Country:US
Practice Address - Phone:562-988-0148
Practice Address - Fax:562-988-0257
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37793OtherCALIFORNIA DENTAL LICENSE