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General NPI Number Information
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NPI Number | 1871083147
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Entity Type | Individual
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Provider Name | TERRENCE LAMONT CAMPBELL DMD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2018
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Last Update Date | 11/29/2019
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Provider Practice Location Address
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Address Line | 2641 COURT DR STE A
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City | GASTONIA
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State | NC
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Zip | 28054
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Country | US
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Telephone | 704-247-9120
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Fax |
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Provider Business Mailing Address
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Address Line | 475 TRAEBERT CIR APT 102
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City | KNIGHTDALE
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State | NC
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Zip | 27545-5808
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Country | US
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Telephone | 919-360-3566
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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 | 10891
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License Number State | NC
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