Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 059428 | NY |
N | 1223X0400X | Orthodontists | 22DI02856300 | NJ |
N | 1223X0400X | Orthodontists | 22DI02856301 | NJ |
N | 1223X0400X | Orthodontists | DS040346 | PA |
NPI | 1003331299 |
---|---|
Provider Name | Dr. Matthew S Campbell |
First Address | New City, NY 10956-2406 |
Second Address | White Plains, NY 10605-2060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2017 |
Last Update Date | 07/01/2022 |