Provider Demographics
NPI:1003997370
Name:CAMPBELL-PINE,PC
Entity Type:Organization
Organization Name:CAMPBELL-PINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-237-1751
Mailing Address - Street 1:205 E BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4903
Mailing Address - Country:US
Mailing Address - Phone:814-237-1751
Mailing Address - Fax:814-237-6069
Practice Address - Street 1:205 E BEAVER AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4903
Practice Address - Country:US
Practice Address - Phone:814-237-1751
Practice Address - Fax:814-237-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty