Jackie Callaway-Campbell, DT

Primary specialty

Dental TherapistTaxonomy code 125J00000X

License

DT136 Issued in MN

Practice address

405 Babcock Blvd E Ste 130
Delano, MN 55328-9144

Phone

(763) 276-1410

Fax

(763) 276-1411

NPI assigned

May 26, 2021

Last updated

May 26, 2021By the provider in NPPES

Sex

Female

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

Medicare enrollment (NPD)

Not 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.

• Crow River Dental

  • General Practice Dentistry
  • Delano, MN
  • NPI 1801166954
  NPD (past)

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1326613787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 7TH ST SE APT 103",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554141272",
            "telephone_number": "302-598-3863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 BABCOCK BLVD E STE 130",
            "city": "DELANO",
            "state": "MN",
            "postal_code": "553289144",
            "telephone_number": "763-276-1410",
            "fax_number": "763-276-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLAWAY-CAMPBELL",
        "first_name": "JACKIE",
        "credential": "DT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-26",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "125J00000X",
            "taxonomy_group": "",
            "desc": "Dental Therapist",
            "state": "MN",
            "license": "DT136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Beth Ann Biskup
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• Robert Craig Christianson, M.D.
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• Dental Therapist in Delano, MN
• Providers in Delano, MN by specialty
• Dental Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.