Healthcare Provider Details

I. General information

NPI: 1518838861
Provider Name (Legal Business Name): CAMPBELL OMS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4466 E YELLOWSTONE PL
CHANDLER AZ
85249-0513
US

IV. Provider business mailing address

4466 E YELLOWSTONE PL
CHANDLER AZ
85249-0513
US

V. Phone/Fax

Practice location:
  • Phone: 801-682-9739
  • Fax:
Mailing address:
  • Phone: 801-682-9739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JORDAN CAMPBELL
Title or Position: OWNER/OPERATOR
Credential: DDS
Phone: 801-682-9739