Provider Demographics
NPI:1124146154
Name:EIDBO, ERIC E (DDS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:E
Last Name:EIDBO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 WIMBLEDON ROAD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-938-5455
Mailing Address - Fax:
Practice Address - Street 1:2401 HIGH SCHOOL AVE
Practice Address - Street 2:STE A
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1801
Practice Address - Country:US
Practice Address - Phone:925-685-2286
Practice Address - Fax:925-685-0376
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice