MEDICARE: DR. PATRICK 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	11987	NC
2	1223G0001X	General Practice Dentistry	34296	TX

General Provider Information

NPI Number	:	1689151508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK CAMPBELL DMD

Provider Business Mailing Address
First Line	:	111 W WILLIAM CANNON DR STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5657
Country	:	US
Telephone Number	:	937-838-5128
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 W WILLIAM CANNON DR STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5657
Country	:	US
Telephone Number	:	737-747-6868
Fax Number	:

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

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	08/20/2025

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