Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2008015942 | MO |
Y | 1223P0300X | Periodontist | 2008015942 | MO |
NPI | 1003079500 |
---|---|
Provider Name | Aaron Glenn Campbell |
First Address | Ft Sill, OK 73503 |
Second Address | Ft Sill, OK 73503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 09/06/2014 |