Healthcare Provider Details

I. General information

NPI: 1891788683
Provider Name (Legal Business Name): WILL G CAMPBELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 N 35TH AVE SUITE 112
PHOENIX AZ
85029-3213
US

IV. Provider business mailing address

12020 N 35TH AVE SUITE 112
PHOENIX AZ
85029-3213
US

V. Phone/Fax

Practice location:
  • Phone: 602-547-9007
  • Fax: 602-547-3438
Mailing address:
  • Phone: 602-547-9007
  • Fax: 602-547-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2463
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: