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General NPI Number Information
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NPI Number | 1528235207
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Entity Type | Organization
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Legal Business Name | KING CAMPBELL, D.D.S., P.L.L.C.
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 228 VILLAGE DR
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-8308
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Country | US
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Telephone | 970-731-2126
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Fax | 970-731-2135
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Provider Business Mailing Address
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Address Line | 228 VILLAGE DR
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-8308
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Country | US
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Telephone | 970-731-2126
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Fax | 970-731-2135
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Authorized Official
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Title or Position | OWNER
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Name | GARRETT KING CAMPBELL
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Credential | D.D.S.
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Telephone | 970-731-2126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7043
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License Number State | CO
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