Provider Demographics
NPI:1003834037
Name:NORTHLAND, EDUARDO R (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:R
Last Name:NORTHLAND
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 1:2825 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3203
Mailing Address - Country:US
Mailing Address - Phone:305-448-1172
Mailing Address - Fax:305-446-2724
Practice Address - Street 1:2825 S.W. 22 STREET
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3203
Practice Address - Country:US
Practice Address - Phone:305-448-1172
Practice Address - Fax:305-446-2724
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist