Provider Demographics
NPI:1992703763
Name:CAMPBELL, DAVID STUART (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STUART
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:STUART
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1955 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3037
Mailing Address - Country:US
Mailing Address - Phone:626-585-9544
Mailing Address - Fax:626-449-4932
Practice Address - Street 1:1955 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3037
Practice Address - Country:US
Practice Address - Phone:626-585-9544
Practice Address - Fax:626-449-4932
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice