Basic Information
| Provider Information | |||||||||
| NPI: | 1497208730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RALPH | ||||||||
| FirstName: | LINZI | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | BLDG 2441 21ST STREET | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT CAMPBELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988977 | ||||||||
| FaxNumber: | 2709560266 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG 2441 21ST STREET | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT CAMPBELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988977 | ||||||||
| FaxNumber: | 2709560266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2016 | ||||||||
| LastUpdateDate: | 08/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 8610 | TN | Y | Dental Providers | Dental Hygienist |
No ID Information.