Provider Demographics
NPI:1548596141
Name:CAMPBELL ORAL SURGERY AND DENTAL IMPLANT CENTER
Entity Type:Organization
Organization Name:CAMPBELL ORAL SURGERY AND DENTAL IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-705-0001
Mailing Address - Street 1:1818 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8029
Mailing Address - Country:US
Mailing Address - Phone:877-705-0001
Mailing Address - Fax:888-878-2118
Practice Address - Street 1:1818 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8029
Practice Address - Country:US
Practice Address - Phone:877-705-0001
Practice Address - Fax:888-878-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000393478CMedicaid
GA511I90018Medicare UPIN