MEDICARE: WILL G 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
1	122300000X	Dentist	2463	AZ

General Provider Information

NPI Number	:	1891788683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILL G CAMPBELL DDS

Provider Business Mailing Address
First Line	:	12020 N 35TH AVE
Second Line	:	SUITE 112
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3213
Country	:	US
Telephone Number	:	602-547-9007
Fax Number	:	602-547-3438

Provider Business Practice Location Address
First Line	:	12020 N 35TH AVE
Second Line	:	SUITE 112
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3213
Country	:	US
Telephone Number	:	602-547-9007
Fax Number	:	602-547-3438

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2007

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Directions to “ WILL G CAMPBELL DDS” Practice Location

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