1649728031 NPI number — LANDSTUHL DENTAL ACTIVITY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649728031 NPI number — LANDSTUHL DENTAL ACTIVITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANDSTUHL DENTAL ACTIVITY
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:
1649728031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WASHINGTON SQUARE,
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAISERSLAUTERN
Provider Business Mailing Address State Name:
KAISERSLAUTERN
Provider Business Mailing Address Postal Code:
67761
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WASHINGTON SQUARE,
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAISERSLAUTERN
Provider Business Practice Location Address State Name:
KAISERSLAUTERN
Provider Business Practice Location Address Postal Code:
67761
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
49063134064443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GLEISNER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
COMMANDER
Authorized Official Telephone Number:
49637194646370

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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