Provider Demographics
NPI:1043961865
Name:AXIOM DENTAL LABORATORIES LLC
Entity Type:Organization
Organization Name:AXIOM DENTAL LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-538-9848
Mailing Address - Street 1:25336 NW 9TH LN
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3589
Mailing Address - Country:US
Mailing Address - Phone:352-538-9848
Mailing Address - Fax:
Practice Address - Street 1:25336 NW 9TH LN
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3589
Practice Address - Country:US
Practice Address - Phone:352-538-9848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory