Healthcare Provider Details

I. General information

NPI: 1750162707
Provider Name (Legal Business Name): CAMPBELL DENTAL ASSOCIATES LEBANON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 N LEBANON ST
LEBANON IN
46052-1515
US

IV. Provider business mailing address

954 BERKHAMSTED LN
CARMEL IN
46032-3683
US

V. Phone/Fax

Practice location:
  • Phone: 706-346-7944
  • Fax:
Mailing address:
  • Phone: 706-346-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. TRENTON MITCHELL CAMPBELL
Title or Position: DENTIST
Credential: DMD
Phone: 706-346-7944