Provider Demographics
NPI:1366617342
Name:CAMPBELL, RICHARD WHITEMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WHITEMAN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 GOODE AVE
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-2932
Mailing Address - Country:US
Mailing Address - Phone:318-377-2745
Mailing Address - Fax:318-377-2746
Practice Address - Street 1:714 GOODE AVE
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-2932
Practice Address - Country:US
Practice Address - Phone:318-377-2745
Practice Address - Fax:318-377-2746
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice