Provider Demographics
NPI:1881811529
Name:CAMPBELL, THOMAS WILLIAM TRUMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM TRUMAN
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 1:164 E H ST
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3231
Mailing Address - Country:US
Mailing Address - Phone:707-745-1994
Mailing Address - Fax:707-745-1995
Practice Address - Street 1:164 E H ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3231
Practice Address - Country:US
Practice Address - Phone:707-745-1994
Practice Address - Fax:707-745-1995
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics