Cody Douglas Campbell, DDS
Individual provider Active NPI Dentist · Grayson, KY
NPI 1235998147 · NPPES record last updated Mar 14, 2024
Key facts
- NPI
- 1235998147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 11082 (KY)
- Practice address
- 132 Interstate Dr # 2
Grayson, KY 41143-1787 - Phone
- (606) 474-5193
- NPI assigned
- Mar 14, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11082 | KY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11082 | KY | Yes |
Addresses
Primary practice location
132 Interstate Dr # 2
Grayson, KY 41143-1787
Mailing address
227 McKnight St
Ashland, KY 41102-4338
Phone (606) 465-5592
Other providers in Grayson, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.