Provider Demographics
NPI:1992147466
Name:JEFFREY MARC EISNER, D.M.D., P.A.
Entity type:Organization
Organization Name:JEFFREY MARC EISNER, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:EISNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-279-8600
Mailing Address - Street 1:11020 N KENDALL DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1246
Mailing Address - Country:US
Mailing Address - Phone:305-279-8600
Mailing Address - Fax:305-279-6918
Practice Address - Street 1:11020 N KENDALL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1246
Practice Address - Country:US
Practice Address - Phone:305-279-8600
Practice Address - Fax:305-279-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL66500OtherMEDICARE PTAN