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NPI Code Detail

MEDICARE: JASON C. CAMPBELL DDS.

MEDICARE: JASON C. CAMPBELL DDS.
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
1122300000XDentist6176AZ

General Provider Information

NPI Number : 1649408576
Entity Type Code : Organization
Provider Name (Legal Business Name) : JASON C. CAMPBELL DDS.
Provider Business Mailing Address
First Line : 139 WHIPPLE ST
Second Line :
City : PRESCOTT
State : AZ
Zip : 86301-1705
Country : US
Telephone Number : 928-776-1208
Fax Number : 928-541-9648
Provider Business Practice Location Address
First Line : 139 WHIPPLE ST
Second Line :
City : PRESCOTT
State : AZ
Zip : 86301-1705
Country : US
Telephone Number : 928-776-1208
Fax Number : 928-541-9648
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. SUE PRIVETTE
Credential :
Telephone Number : 928-776-1208
Provider Enumeration Date : 06/30/2009
Last Update Date : 06/30/2009

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