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General NPI Number Information
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NPI Number | 1710657630
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Entity Type | Organization
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Legal Business Name | CAMPBELL DENTAL GROUP, PC
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 5610 N LOMBARD ST
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City | PORTLAND
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State | OR
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Zip | 97203-4224
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Country | US
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Telephone | 503-283-2553
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Fax |
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Provider Business Mailing Address
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Address Line | 17065 SW KINGLET DR
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City | SHERWOOD
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State | OR
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Zip | 97140-8195
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Country | US
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Telephone | 503-313-5874
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EVAN CAMPBELL
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Credential | DMD
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Telephone | 503-283-2553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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