Provider Demographics
NPI:1124772330
Name:DAVID M. EBERHARD DDS PC
Entity type:Organization
Organization Name:DAVID M. EBERHARD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:EBERHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-418-0699
Mailing Address - Street 1:16 NORWICH RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1026
Mailing Address - Country:US
Mailing Address - Phone:313-418-0699
Mailing Address - Fax:
Practice Address - Street 1:44710 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5481
Practice Address - Country:US
Practice Address - Phone:586-739-0550
Practice Address - Fax:586-739-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental