Provider Demographics
NPI:1114159365
Name:JOE S. CAMPBELL, DDSPC
Entity Type:Organization
Organization Name:JOE S. CAMPBELL, DDSPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-283-1820
Mailing Address - Street 1:48 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1842
Mailing Address - Country:US
Mailing Address - Phone:706-283-1820
Mailing Address - Fax:706-283-1824
Practice Address - Street 1:48 LAUREL DR
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1842
Practice Address - Country:US
Practice Address - Phone:706-283-1820
Practice Address - Fax:706-283-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty