Provider Demographics
NPI:1487922456
Name:LARRY W. PAMPEL D.D.S., INC.
Entity type:Organization
Organization Name:LARRY W. PAMPEL D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PAMPEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-987-5733
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-0848
Mailing Address - Country:US
Mailing Address - Phone:219-987-5733
Mailing Address - Fax:219-987-6162
Practice Address - Street 1:534 N HALLECK ST
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-9553
Practice Address - Country:US
Practice Address - Phone:219-987-5733
Practice Address - Fax:219-987-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
IN12006974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty