Campbell Walters, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019.031733 Issued in IL

Practice address

2380 N Truman Blvd
Crystal City, MO 63019-1037

Phone

(636) 937-9193

Fax

(314) 200-9691

NPI assigned

Aug 10, 2016

Sex

Male

Sole proprietor

No

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)

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.

• MDP of Missouri LLC

  • General Practice Dentistry
  • Hazelwood, MO
  • NPI 1356202378
  NPD (past)
• Nikodem Dental Holdings, Inc.

  • Dental Clinic/Center
  • Crystal City, MO
  • NPI 1912651423
  NPD (past)

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1891249652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4337 BUTLER HILL RD STE L",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283735",
            "telephone_number": "314-732-4591",
            "fax_number": "314-200-9691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 N TRUMAN BLVD",
            "city": "CRYSTAL CITY",
            "state": "MO",
            "postal_code": "630191037",
            "telephone_number": "636-937-9193",
            "fax_number": "314-200-9691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "CAMPBELL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-10",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.031733",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2016025042",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Trudell, MA
• Twin City Healt Services
• Twin City Residential Care, Inc.
• William L Underwood, MD
• Urology Today, LLC
• Scott Alan Walther
• Steven Duane Williams
• XRT 1, Inc
• XRT II, Inc

• Dentist in Crystal City, MO
• Providers in Crystal City, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; 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.