Healthcare Provider Details

I. General information

NPI: 1356344634
Provider Name (Legal Business Name): STEVEN WOODROW CAMPBELL DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 LANCASTER DR NE
SALEM OR
97301-4728
US

IV. Provider business mailing address

434 LANCASTER DR NE
SALEM OR
97301-4728
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-0721
  • Fax: 503-399-8583
Mailing address:
  • Phone: 503-399-0721
  • Fax: 503-399-8583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD4894
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: