Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 9485 | CO |
NPI | 1013236025 |
---|---|
Provider Name | Dr. Samantha A Campbell |
First Address | Denver, CO 80238-3442 |
Second Address | Denver, CO 80238-3442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2010 |
Last Update Date | 01/06/2010 |