=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235214743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GALE CHARLES CAMPBELL DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 1ST AVE SW
-----------------------------------------------------
City | EPHRATA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98823-1842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-754-5236
-----------------------------------------------------
Fax | 509-754-3248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 1ST AVE SW
-----------------------------------------------------
City | EPHRATA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98823-1842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-754-5236
-----------------------------------------------------
Fax | 509-754-3248
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4276
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------