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General NPI Number Information
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NPI Number | 1235243890
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Entity Type | Individual
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Provider Name | BENJAMIN CAMPBELL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 3136 KATIE IDA LN
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-9273
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Country | US
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Telephone | 828-572-8376
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Fax |
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Provider Business Mailing Address
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Address Line | 3136 KATIE IDA LN
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-9273
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021.002951
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6491-15
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License Number State | WI
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