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General NPI Number Information
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NPI Number | 1699904326
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Entity Type | Organization
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Legal Business Name | .ALFRED B. LAUDER, D.D.S.
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 33 GOODEN AVE
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City | DOVER
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State | DE
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Zip | 19904-4143
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Country | US
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Telephone | 302-678-9742
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Fax | 302-678-9742
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Provider Business Mailing Address
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Address Line | 33 GOODEN AVE
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City | DOVER
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State | DE
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Zip | 19904-4143
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Country | US
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Telephone | 302-678-9742
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Fax | 302-678-9742
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | ALFRED BRUCE LAUDER
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Credential | D.D.S.
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Telephone | 302-678-9742
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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 | G1-0001081
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License Number State | DE
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