Provider Demographics
NPI:1003486671
Name:L & L BEACH STREET, LLC
Entity Type:Organization
Organization Name:L & L BEACH STREET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LECOMPTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-253-3413
Mailing Address - Street 1:208 SOUTH BEACH STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114
Mailing Address - Country:US
Mailing Address - Phone:386-253-3413
Mailing Address - Fax:386-253-6002
Practice Address - Street 1:208 SOUTH BEACH STREET
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-253-3413
Practice Address - Fax:386-253-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty