Provider Demographics
NPI:1003922519
Name:AUBERT, ERIC J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:AUBERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 FOREST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2113
Mailing Address - Country:US
Mailing Address - Phone:314-367-7200
Mailing Address - Fax:314-367-0508
Practice Address - Street 1:4527 FOREST PARK AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2113
Practice Address - Country:US
Practice Address - Phone:314-367-7200
Practice Address - Fax:314-367-0508
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0146771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice