Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN1857547 | MA |
Y | 213EG0000X | General Practice | DN1857547 | MA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DL12923 | MA |
NPI | 1366892085 |
---|---|
Provider Name | Tiffany Hong Campbell |
First Address | Quincy, MA 02170-3847 |
Second Address | Quincy, MA 02170-3847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2016 |
Last Update Date | 17/03/2018 |