William Michael Campbell, DMD

Individual provider Active NPI General Practice Dentistry · Clinton, MS

NPI 1881709996 · NPPES record last updated Jul 9, 2007

Key facts

NPI
1881709996
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
1662-75 (MS)
Practice address
405 Masonic Dr
Clinton, MS 39056-5335
Phone
(601) 924-0226
Fax
(601) 924-7788
NPI assigned
Aug 20, 2006
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

LicenseStateTypeSpecialty
1662-75MSMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1662-75 MS Yes

Addresses

Primary practice location

405 Masonic Dr
Clinton, MS 39056-5335

Mailing address

405 Masonic Dr
Clinton, MS 39056-5335
Phone (601) 924-0226

Other identifiers

IdentifierTypeStateIssuer
00064450MedicaidMS

Other providers in Clinton, MS

All providers in Clinton, MS · General Practice Dentistry in Mississippi

Sources for this page

Verify at the official NPI Registry.