=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861700924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LLOYD A ANCMAN DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2010
-----------------------------------------------------
Last Update Date | 12/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 390 NORTH LOOP RD
-----------------------------------------------------
City | FORT IRWIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-383-5289
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2441 21ST ST
-----------------------------------------------------
City | FORT CAMPBELL
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42223-5582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-412-2787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 6077
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6077
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------