Provider Demographics
NPI:1487774584
Name:CAMPBELL, ELISA LOBUE (DDS)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:LOBUE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:LOBUE CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3930 S BRISTOL ST
Mailing Address - Street 2:STE #202
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704
Mailing Address - Country:US
Mailing Address - Phone:714-241-7027
Mailing Address - Fax:714-241-0151
Practice Address - Street 1:3930 S BRISTOL STREET
Practice Address - Street 2:STE #202
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704
Practice Address - Country:US
Practice Address - Phone:714-293-3727
Practice Address - Fax:714-241-0151
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist