Provider Demographics
NPI:1366718876
Name:CAMPBELL, JOHN W (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1002 N CHURCH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1439
Mailing Address - Country:US
Mailing Address - Phone:336-275-6600
Mailing Address - Fax:336-275-6699
Practice Address - Street 1:1002 N CHURCH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1439
Practice Address - Country:US
Practice Address - Phone:336-275-6600
Practice Address - Fax:336-275-6699
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC39011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991340Medicaid