Provider Demographics
NPI:1023044575
Name:ECKEL, PETER BARTLETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BARTLETT
Last Name:ECKEL
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:PO BOX 7368
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03247-7368
Mailing Address - Country:US
Mailing Address - Phone:603-524-7455
Mailing Address - Fax:
Practice Address - Street 1:25 COUNTRY CLUB RD
Practice Address - Street 2:301 VILLAGE WEST
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6972
Practice Address - Country:US
Practice Address - Phone:603-524-7455
Practice Address - Fax:603-524-7015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0201841YONHO1OtherANTHEM BC PROVIDER NO.
NH89191841Medicaid