=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316114416
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARAH J. CAMPBELL, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2008
-----------------------------------------------------
Last Update Date | 05/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 CARROUSEL DR
-----------------------------------------------------
City | TONKAWA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74653-1041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-628-2528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 465 104 CARROUSEL DR.
-----------------------------------------------------
City | TONKAWA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74653-0465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-628-2528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SARAH J CAMPBELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 580-628-2528
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 5539
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------