Provider Demographics
NPI:1114146131
Name:CAMPBELL AND COVINGTON ORTHODONTICS
Entity Type:Organization
Organization Name:CAMPBELL AND COVINGTON ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-251-1100
Mailing Address - Street 1:1516 DOCTORS CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7404
Mailing Address - Country:US
Mailing Address - Phone:910-251-1100
Mailing Address - Fax:910-251-9871
Practice Address - Street 1:1516 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7404
Practice Address - Country:US
Practice Address - Phone:910-251-1100
Practice Address - Fax:910-251-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty