Provider Demographics
NPI:1891788683
Name:CAMPBELL, WILL G (DDS)
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:G
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 1:12020 N 35TH AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3213
Mailing Address - Country:US
Mailing Address - Phone:602-547-9007
Mailing Address - Fax:602-547-3438
Practice Address - Street 1:12020 N 35TH AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3213
Practice Address - Country:US
Practice Address - Phone:602-547-9007
Practice Address - Fax:602-547-3438
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist