Healthcare Provider Details

I. General information

NPI: 1841620341
Provider Name (Legal Business Name): STEPHANIE CAMPBELL DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9008 MAIN ST
MC KEAN PA
16426-1454
US

IV. Provider business mailing address

9008 MAIN ST
MC KEAN PA
16426-1454
US

V. Phone/Fax

Practice location:
  • Phone: 906-286-0657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1508091679
License Number StateOH

VIII. Authorized Official

Name: DR. STEPHANIE CAMPBELL
Title or Position: OWNER
Credential:
Phone: 906-286-0657