Provider Demographics
NPI:1992807218
Name:CAMPBELL, JENNIFER EVA (RDH)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:EVA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:EVA
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:411 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-1357
Mailing Address - Country:US
Mailing Address - Phone:541-276-2009
Mailing Address - Fax:
Practice Address - Street 1:73265 CONFEDERATED WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4174124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR171037Medicaid