Provider Demographics
NPI:1700903036
Name:LANDMARK DENTAL GROUP
Entity Type:Organization
Organization Name:LANDMARK DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-352-6494
Mailing Address - Street 1:175 E CAPITOL ST
Mailing Address - Street 2:STE 14
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39201-2135
Mailing Address - Country:US
Mailing Address - Phone:601-352-6494
Mailing Address - Fax:601-354-4853
Practice Address - Street 1:175 E CAPITOL ST
Practice Address - Street 2:STE 14
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-2135
Practice Address - Country:US
Practice Address - Phone:601-352-6494
Practice Address - Fax:601-354-4853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1662751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty