Provider Demographics
NPI:1699782128
Name:EICHHORN, SCOTT WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:EICHHORN
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 1:2915 E MOORE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4821
Mailing Address - Country:US
Mailing Address - Phone:501-268-5115
Mailing Address - Fax:501-268-2152
Practice Address - Street 1:2915 E MOORE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4821
Practice Address - Country:US
Practice Address - Phone:501-268-5115
Practice Address - Fax:501-268-2152
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T975OtherBCBS PROVIDER ID