Provider Demographics
NPI:1073644753
Name:EADES, DAVID E (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:EADES
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 1:2217 HIGHWAY 110 W
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3404
Mailing Address - Country:US
Mailing Address - Phone:501-362-2962
Mailing Address - Fax:501-362-6822
Practice Address - Street 1:2217 HIGHWAY 110 W
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3404
Practice Address - Country:US
Practice Address - Phone:501-362-2962
Practice Address - Fax:501-362-6822
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist