Healthcare Provider Details

I. General information

NPI: 1487922456
Provider Name (Legal Business Name): LARRY W. PAMPEL D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 N HALLECK ST
DEMOTTE IN
46310-9553
US

IV. Provider business mailing address

PO BOX 848
DEMOTTE IN
46310-0848
US

V. Phone/Fax

Practice location:
  • Phone: 219-987-5733
  • Fax: 219-987-6162
Mailing address:
  • Phone: 219-987-5733
  • Fax: 219-987-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12006974
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. LARRY WAYNE PAMPEL
Title or Position: OWNER
Credential: DDS
Phone: 219-987-5733