Provider Demographics
NPI:1023569308
Name:MICHAEL S CAMPBELL DDS
Entity Type:Organization
Organization Name:MICHAEL S CAMPBELL DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-852-9088
Mailing Address - Street 1:24722 104TH AVE SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5322
Mailing Address - Country:US
Mailing Address - Phone:253-852-9088
Mailing Address - Fax:253-852-9003
Practice Address - Street 1:24722 104TH AVE SE
Practice Address - Street 2:SUITE 101
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5322
Practice Address - Country:US
Practice Address - Phone:253-852-9088
Practice Address - Fax:253-852-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601044129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty