Provider Demographics
NPI:1922246297
Name:ANDREW J CAMPBELL DDS, PC
Entity Type:Organization
Organization Name:ANDREW J CAMPBELL DDS, PC
Other - Org Name:KILLEEN ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-526-5667
Mailing Address - Street 1:2703 E STAN SCHLUETER LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6758
Mailing Address - Country:US
Mailing Address - Phone:254-526-5667
Mailing Address - Fax:254-526-7200
Practice Address - Street 1:2703 E STAN SCHLUETER LOOP
Practice Address - Street 2:STE 100
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542
Practice Address - Country:US
Practice Address - Phone:254-526-5667
Practice Address - Fax:254-526-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty