Provider Demographics
NPI:1659363653
Name:CAMPBELL, SARAH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:104 CARROUSEL DR
Mailing Address - Street 2:PO BOX 465
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-3545
Mailing Address - Country:US
Mailing Address - Phone:580-628-2528
Mailing Address - Fax:580-628-3023
Practice Address - Street 1:104 CARROUSEL DR
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-3545
Practice Address - Country:US
Practice Address - Phone:580-628-2528
Practice Address - Fax:580-628-3023
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice