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General NPI Number Information
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NPI Number | 1003486671
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Entity Type | Organization
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Legal Business Name | L & L BEACH STREET, LLC
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 208 SOUTH BEACH STREET
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City | DAYTONA BEACH
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State | FL
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Zip | 32114
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Country | US
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Telephone | 386-253-3413
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Fax | 386-253-6002
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Provider Business Mailing Address
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Address Line | 208 SOUTH BEACH STREET
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City | DAYTONA BEACH
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State | FL
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Zip | 32114
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Country | US
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Telephone | 386-253-3413
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Fax | 386-253-6002
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | EUGENE JOSEPH LECOMPTE
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Credential | D.D.S
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Telephone | 386-253-3413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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