Healthcare Provider Details

I. General information

NPI: 1184689960
Provider Name (Legal Business Name): US ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 28038
VILSECK GE
09244
DE

IV. Provider business mailing address

UNIT 28038 US ARMY DENTAL ACTIVITY BAVARIA
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 011499662834738
  • Fax:
Mailing address:
  • Phone: 11-499-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number20436
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number8059
License Number StateKY

VIII. Authorized Official

Name: DR. ERIC ALLEN HALL
Title or Position: PROSTHODONTIST
Credential: D.D.S.
Phone: 502-624-9670