MEDICARE: W LYNN CAMPBELL DMD. PA.

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	SC-1311	SC

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	:	1659437788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W LYNN CAMPBELL DMD. PA.

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	:	PRESIDENT
Name	:	DR. WILLIAM LYNN CAMPBELL
Credential	:	DMD
Telephone Number	:	803-732-0900

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	02/28/2009

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