MEDICARE: CAMPBELL ORAL SURGERY AND DENTAL IMPLANT CENTER

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	10762	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548596141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPBELL ORAL SURGERY AND DENTAL IMPLANT CENTER

Provider Business Mailing Address
First Line	:	1818 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8029
Country	:	US
Telephone Number	:	877-705-0001
Fax Number	:	888-878-2118

Provider Business Practice Location Address
First Line	:	1818 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8029
Country	:	US
Telephone Number	:	877-705-0001
Fax Number	:	888-878-2118

Authorized Official
Title or Position	:	BUSINESS OFFICE DIRECTOR
Name	:	LINDA ABERNATHY
Credential	:
Telephone Number	:	877-705-0001

Provider Enumeration Date	:	11/02/2009
Last Update Date	:	11/02/2009

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Directions to “CAMPBELL ORAL SURGERY AND DENTAL IMPLANT CENTER ” Practice Location

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