Jordan Campbell, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D011290 Issued in AZ

Practice address

3185 Clearwater Dr Ste B
Prescott, AZ 86305-7119

Phone

(928) 775-2545

NPI assigned

Mar 30, 2017

Last updated

Jan 31, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 6, 2023 through Apr 6, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Campbell Oms PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Chandler, AZ
  • NPI 1518838861
  NPD Authorized official
• North Valley Endodontics, P.a.

  dba Valley Endodontic Specialty Group

  • Endodontics
  • Phoenix, AZ
  • NPI 1659308641
  NPD (past)
• Yavapai Oral and Facial Surgery PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Prescott Valley, AZ
  • NPI 1669885802
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1194257022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 S LAKEVIEW DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863016625",
            "telephone_number": "801-682-9739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3185 CLEARWATER DR STE B",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057119",
            "telephone_number": "928-775-2545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "JORDAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-30",
        "last_updated": "2024-01-31",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D011290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Derek Calhoun, APRN
• Kathleen Callender, M.D.
• Ciera Cammilleri
• Jared S Campbell, AT
• Jason Clay Campbell, DDS
• Kimberly Campbell, MA, LPC
• Robert Campbell, DO
• Thomas Campbell, MD
• Quinn Cannon
• Stephen A Cantor, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.