Provider Demographics
NPI:1487806642
Name:ECKERT, BRIAN W (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:ECKERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 10001
Mailing Address - Street 2:PMB 807
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-233-1100
Mailing Address - Fax:670-233-2233
Practice Address - Street 1:BLK. 2, GROUND FLOOR, D'TORRES BLDG
Practice Address - Street 2:MIDDLE ROAD, GARAPAN
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-233-1100
Practice Address - Fax:670-233-2233
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ00921223G0001X
ZZ103311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice