Provider Demographics
NPI:1710565148
Name:CAMPBELL, RANDON (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDON
Middle Name:
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 1:11455 CANAL XING
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-6747
Mailing Address - Country:US
Mailing Address - Phone:912-217-4953
Mailing Address - Fax:
Practice Address - Street 1:1609 NORMAN DR STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-3753
Practice Address - Country:US
Practice Address - Phone:229-269-4607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122386122300000X
FLDN25818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist