Provider Demographics
NPI:1942562756
Name:CAMPBELL BOURLAND DDS, PLLC
Entity Type:Organization
Organization Name:CAMPBELL BOURLAND DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:BOURLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:214-564-5597
Mailing Address - Street 1:1151 N BUCKNER BLVD
Mailing Address - Street 2:STE 406
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1151 N BUCKNER BLVD
Practice Address - Street 2:STE 406
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3426
Practice Address - Country:US
Practice Address - Phone:214-328-6354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty