Healthcare Provider Details

I. General information

NPI: 1679711097
Provider Name (Legal Business Name): DAVID LEE REDMOND DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 03/15/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DENTAL ACTIVITY RHEINLAND PFALZ
APO AE
09180-0003
US

IV. Provider business mailing address

CMR 402 BOX 284
APO AE
09180-0003
US

V. Phone/Fax

Practice location:
  • Phone: 123-456-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8696
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: