=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841484623
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA JEAN RAMMER DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2007
-----------------------------------------------------
Last Update Date | 09/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 604 MICHIGAN AVE
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-3425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-458-9331
-----------------------------------------------------
Fax | 920-458-7480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 604 MICHIGAN AVE
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-3425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-458-9331
-----------------------------------------------------
Fax | 920-458-7480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 6164
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------