Provider Demographics
NPI:1336293547
Name:CAMPBELL, JAMES R JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:CAMPBELL
Suffix:JR
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:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313
Mailing Address - Country:US
Mailing Address - Phone:406-778-5150
Mailing Address - Fax:406-778-5151
Practice Address - Street 1:202 S 4TH ST W
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:MT
Practice Address - Zip Code:59313
Practice Address - Country:US
Practice Address - Phone:406-778-5150
Practice Address - Fax:406-778-5151
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT111197Medicaid
MT5511536OtherBLUECHIP
ND41167Medicaid
MT5511531OtherBLUECHIP
ND942710OtherBLUE CROSS BLUE SHIELD ND
MT0111214Medicaid
MT19064OtherBLUE CROSS BLUE SHIELD MT
MT40784OtherBLUE CROSS BLUE SHIELD MT