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General NPI Number Information
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NPI Number | 1659455913
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Entity Type | Individual
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Provider Name | STEPHEN IAN CAMPBELL DDS
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 6333 E SKELLY DR
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City | TULSA
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State | OK
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Zip | 74135-6106
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Country | US
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Telephone | 918-664-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 5809 N 32ND ST
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City | BROKEN ARROW
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State | OK
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Zip | 74014-5119
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Country | US
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Telephone | 509-939-6364
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D10407
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4747
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE8341
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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