Provider Demographics
NPI:1659722189
Name:DOD
Entity Type:Organization
Organization Name:DOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WOLPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-371-7787
Mailing Address - Street 1:US ARMY DENTAL ACTIVITY
Mailing Address - Street 2:4431 68TH STREET
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAL ACTIVITY
Practice Address - Street 2:4431 68TH STREET
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-3105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06749122300000X
NE5863261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty