Basic Information
| Provider Information | |||||||||
| NPI: | 1184689960 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | US ARMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIT 28038 | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY BAVARIA | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0114996628 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIT 28038 | ||||||||
| Address2: | |||||||||
| City: | VILSECK | ||||||||
| State: | GE | ||||||||
| PostalCode: | 09244 | ||||||||
| CountryCode: | DE | ||||||||
| TelephoneNumber: | 011499662834738 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 05/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PROSTHODONTIST | ||||||||
| AuthorizedOfficialTelephone: | 5026249670 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.D.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | 20436 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Dental | 261QD0000X | 8059 | KY | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.