Needs +1 in front. But that applies wherever you're using it. So for me to ring you from the UK it'll be +1 281-460-1111 regardless of whether you're physically in the US, Canada, Germany or even in the UK.
Because your phone is a US phone, essentially the way it works is the number routes to the US and it's then down to your phone company to route it to the location of the handset.
Don't worry about the variable lengths of the German numbers. Apparently Germany isn't consistent with the lengths of the numbers.
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