Active NPI
Casey McCray Campbell, D.D.S., M.S.
- Periodontics
- Jbsa Lackland, TX
National Provider Identifier
1366460693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 21470
- Practice address
- 1100 Wilford Hall Loop
Jbsa Lackland, TX 78236-5638 - Phone
- (210) 292-6280
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | |||
| Periodontics | 1223P0300X | 21470 | TX | Primary |
Addresses
Primary practice location
1100 Wilford Hall Loop
Jbsa Lackland, TX 78236-5638
Mailing address
2133 Pepperrell St
Jbsa Lackland, TX 78236-5313
Phone (210) 292-6280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21470 | TX | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690934400000",
"number": "1366460693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2133 PEPPERRELL ST",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782365313",
"telephone_number": "210-292-6280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782365638",
"telephone_number": "210-292-6280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "CASEY",
"middle_name": "MCCRAY",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2023-08-02",
"certification_date": "2023-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "21470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jbsa Lackland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.