MEDICARE: DR. WILLIAM LYNN CAMPBELL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	SC1311	SC

General Provider Information

NPI Number	:	1184629842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM LYNN CAMPBELL DMD

Provider Business Mailing Address
First Line	:	124 HARBISON BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-2204
Country	:	US
Telephone Number	:	803-732-0900
Fax Number	:	803-732-0990

Provider Business Practice Location Address
First Line	:	124 HARBISON BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-2204
Country	:	US
Telephone Number	:	803-732-0900
Fax Number	:	803-732-0990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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