Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1033368063 |
---|---|
Provider Name | Mr. Justin Campbell |
First Address | Mobile, AL 36608-8322 |
Second Address | Mobile, AL 36608-8322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2008 |
Last Update Date | 15/09/2008 |