Healthcare Provider Details

I. General information

NPI: 1245683150
Provider Name (Legal Business Name): LDENTAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PULASKI BARRACKS
KAISERSLAUTERN RHPL
67655
DE

IV. Provider business mailing address

KANDELBRUNNENSTRASSE
RAMMELSBACH RHLP
66887
DE

V. Phone/Fax

Practice location:
  • Phone: 063134064460
  • Fax:
Mailing address:
  • Phone: 063816008161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS HANS PREIS
Title or Position: LABTECH
Credential:
Phone: 314-493-4460