Healthcare Provider Details

I. General information

NPI: 1992760946
Provider Name (Legal Business Name): MICHAEL A. CAMPBELL, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 AIRPORT BLVD SUITE 1
MOBILE AL
36608
US

IV. Provider business mailing address

6350 AIRPORT BLVD SUITE 1
MOBILE AL
36608
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-9113
  • Fax:
Mailing address:
  • Phone: 251-342-9113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3922
License Number StateAL

VIII. Authorized Official

Name: DR. MICHAEL A CAMPBELL
Title or Position: DOCTOR
Credential: DMD
Phone: 251-342-9113