Provider Demographics
NPI:1992963086
Name:THE CAMPBELL DENTAL GROUP
Entity type:Organization
Organization Name:THE CAMPBELL DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-256-0009
Mailing Address - Street 1:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31107-0478
Mailing Address - Country:US
Mailing Address - Phone:404-256-0009
Mailing Address - Fax:404-256-0029
Practice Address - Street 1:4840 ROSWELL RD NE
Practice Address - Street 2:BUILDING A SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2639
Practice Address - Country:US
Practice Address - Phone:404-256-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0122501223G0001X
GA0122491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty