Provider Demographics
NPI:1588788970
Name:CAMPBELL, ALISON DAMARODAS (DDS)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:DAMARODAS
Last Name:CAMPBELL
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 1:1103 RIVERY BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3034
Mailing Address - Country:US
Mailing Address - Phone:512-864-9595
Mailing Address - Fax:
Practice Address - Street 1:1103 RIVERY BLVD
Practice Address - Street 2:STE 140
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3034
Practice Address - Country:US
Practice Address - Phone:512-864-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry