1316133721 NPI number — BRANCH DENTAL CLINIC CAMP LEJEUNE

Table of content: DR. RACHEL I. TOTH M.D. (NPI 1073558896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316133721 NPI number — BRANCH DENTAL CLINIC CAMP LEJEUNE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRANCH DENTAL CLINIC CAMP LEJEUNE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316133721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BREWSTER BLVD
Provider Second Line Business Mailing Address:
CODE 08/ZD
Provider Business Mailing Address City Name:
CAMP LEJEUNE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28547-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-450-4159
Provider Business Mailing Address Fax Number:
910-450-4194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BREWSTER BLVD
Provider Second Line Business Practice Location Address:
CODE 08/ZD
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28547-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-450-4159
Provider Business Practice Location Address Fax Number:
910-450-4194
Provider Enumeration Date:
09/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONDON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
NAVY MEDICINE UBO PROGRAM MANAGER
Authorized Official Telephone Number:
240-401-3643

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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