Provider Demographics
NPI:1386048262
Name:ESCHENBACH, DANIEL GERHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GERHARD
Last Name:ESCHENBACH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12613 TAYLORSVILLE RD.
Mailing Address - Street 2:SUITE #17
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299
Mailing Address - Country:US
Mailing Address - Phone:502-266-5355
Mailing Address - Fax:
Practice Address - Street 1:12613 TAYLORSVILLE RD.
Practice Address - Street 2:SUITE #17
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299
Practice Address - Country:US
Practice Address - Phone:502-266-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY95111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice