NPIMap

Organization Active NPI

Deirder M Campbell

Doing business as Colonial Dental Group

  • Dentist
  • Fort Myers, FL
National Provider Identifier
1669642641
Registry record updated Mar 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN16533 Issued in FL
Legal business name
DEIRDER M CAMPBELL
Doing business as
Colonial Dental Group
Practice address
4447 Camino Real Way
Fort Myers, FL 33966-1019
Phone
(239) 936-7400
Fax
(239) 936-7696
NPI assigned
Mar 6, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Deirdre M Campbell, D.M.D.NPI 1750475398
Title
Owner
Phone
(239) 936-7400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN16533 FL Primary

Addresses

Primary practice location

4447 Camino Real Way
Fort Myers, FL 33966-1019

Mailing address

4447 Camino Real Way
Fort Myers, FL 33966-1019
Phone (239) 936-7400

Other identifiers 2

IdentifierTypeStateIssuer
62322OtherFLBC/BS
4131731OtherFLBC/BS

Other names 1

  • Colonial Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

4447 Camino Real Way
Fort Myers, FL 33966
Phone (239) 936-7400

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204761600000",
    "number": "1669642641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4447 CAMINO REAL WAY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661019",
            "telephone_number": "239-936-7400",
            "fax_number": "239-936-7696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4447 CAMINO REAL WAY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661019",
            "telephone_number": "239-936-7400",
            "fax_number": "239-936-7696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEIRDER M CAMPBELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-06",
        "last_updated": "2008-03-06",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "DEIRDRE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-936-7400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "62322",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "4131731",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.