Basic Information
Provider Information | |||||||||
NPI: | 1437121530 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | EIKENBERG | ||||||||
FirstName: | STEVEN | ||||||||
MiddleName: | L. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DDS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | HQS, USA DENTAC | ||||||||
Address2: | 2410 STANLEY ROAD | ||||||||
City: | FT SAM HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 782346200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2102952743 | ||||||||
FaxNumber: | 2102952602 | ||||||||
Practice Location | |||||||||
Address1: | HQS, USA DENTAC | ||||||||
Address2: | 2410 STANLEY ROAD | ||||||||
City: | FT SAM HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 782346200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2102952743 | ||||||||
FaxNumber: | 2102952602 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/02/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 21950 | TX | Y |   | Dental Providers | Dentist | General Practice | 1223G0001X | 4786 | WI | N |   | Dental Providers | Dentist | General Practice |
No ID Information.