Provider Demographics
NPI:1396907440
Name:EISENBERG, DEAN STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:STEVEN
Last Name:EISENBERG
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 1:6551 WILSON MILLS
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3425
Mailing Address - Country:US
Mailing Address - Phone:440-684-1133
Mailing Address - Fax:440-684-1199
Practice Address - Street 1:6551 WILSON MILLS
Practice Address - Street 2:SUITE 102
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3425
Practice Address - Country:US
Practice Address - Phone:440-684-1133
Practice Address - Fax:440-684-1199
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300175091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2206651Medicaid