Provider Demographics
NPI:1972640118
Name:SOWELL, CAMPBELL MILLER JR (D D S)
Entity Type:Individual
Prefix:DR
First Name:CAMPBELL
Middle Name:MILLER
Last Name:SOWELL
Suffix:JR
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3212
Mailing Address - Country:US
Mailing Address - Phone:931-388-5269
Mailing Address - Fax:931-381-1757
Practice Address - Street 1:208 W 6TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3212
Practice Address - Country:US
Practice Address - Phone:931-388-5269
Practice Address - Fax:931-381-1757
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 19621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice