Healthcare Provider Details

I. General information

NPI: 1740849579
Provider Name (Legal Business Name): MICHAEL CAMPBELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 ALLENTOWN RD
LIMA OH
45805-1749
US

IV. Provider business mailing address

205 PARKVIEW DR
BLUFFTON OH
45817-1087
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-4036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025837
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: