Provider Demographics
NPI:1124180310
Name:CAMPBELL, THOMAS W (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E BALTIMORE ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-1535
Mailing Address - Country:US
Mailing Address - Phone:410-539-7006
Mailing Address - Fax:410-685-4742
Practice Address - Street 1:201 E BALTIMORE ST
Practice Address - Street 2:SUITE 130
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-1535
Practice Address - Country:US
Practice Address - Phone:410-539-7006
Practice Address - Fax:410-685-4742
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist