Jerold Campbell

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

4120-20 Issued in MS

Practice address

106 Merchants Drive
Oxford, MS 38655

Phone

(901) 870-5529

NPI assigned

Mar 26, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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 and National Provider Directory roles.

• Oxford Pediatric Dentistry, PLLC

  • Dental Clinic/Center
  • Oxford, MS
  • NPI 1700515905
  NPD Authorized official
• Boa Vida Hospital of Aberdeen, Ms, LLC

  • Rural Health Clinic/Center
  • Aberdeen, MS
  • NPI 1245757301
  NPD (past)
• Boa Vida Hospital of Aberdeen, Ms, LLC

  • Multi-Specialty Clinic/Center
  • Aberdeen, MS
  • NPI 1710405741
  NPD (past)

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1831694629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 MERCHANTS DRIVE",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "38655",
            "telephone_number": "901-870-5529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 MERCHANTS DRIVE",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "38655",
            "telephone_number": "901-870-5529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "JEROLD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-26",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MS",
            "license": "4120-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Gabriela Calderon, LMSW
• Melissa Lynn Caldwell, LCSW
• Deidre L Callicut
• Camellia Hospice of North Mississippi, LLC
• Campbell Clinic PC
• Mark Edward Campbell, M.D.
• Matthew Warren Campbell, PH.D.
• Mia Desirae Campbell
• Tori Ashanti Campbell, BSW
• John E Cantrell, M.D.

• Pediatric Dentistry in Oxford, MS
• Providers in Oxford, MS by specialty
• Pediatric Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.