Healthcare Provider Details

I. General information

NPI: 1760761746
Provider Name (Legal Business Name): KARSTEN J HAIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USNMRTU IWAKUNI, BLDG 110 BLDG 110, MCAS IWAKUNI
IWAKUNI YAMAGUCHI
7400025
JP

IV. Provider business mailing address

PSC 561 BOX 1877
FPO AP
96310-0019
US

V. Phone/Fax

Practice location:
  • Phone: 355-255-8524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8007492-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: