Provider Demographics
NPI:1093261638
Name:EIDE, ERIKA JANE
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:JANE
Last Name:EIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 HANOVER LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3653
Mailing Address - Country:US
Mailing Address - Phone:956-832-7780
Mailing Address - Fax:
Practice Address - Street 1:3312 TEASLEY LN STE 200
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8312
Practice Address - Country:US
Practice Address - Phone:956-832-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32089122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist