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General NPI Number Information
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NPI Number | 1063865970
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Entity Type | Organization
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Legal Business Name | LDENTAC
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | CMR 402
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City | KAISERSLAUTERN
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State | RH-PL
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Zip | 09227
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Country | DE
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Telephone | 314-493-4460
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Fax |
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Provider Business Mailing Address
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Address Line | CMR 402
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City | KAISERSLAUTERN
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State | RH-PL
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Zip | 09227
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Country | DE
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PULASKI LAB NCOIC
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Name | MR. JASON NGUYEN
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Credential |
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Telephone | 314-493-4460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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