Provider Demographics
NPI:1104213420
Name:EICKMEIER, DWIGHT (DDS)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:
Last Name:EICKMEIER
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 1:7 INDIAN RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BEND
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:NOM 1T0
Mailing Address - Country:CA
Mailing Address - Phone:646-259-1898
Mailing Address - Fax:888-456-0253
Practice Address - Street 1:200 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3975
Practice Address - Country:US
Practice Address - Phone:757-769-7155
Practice Address - Fax:888-456-0253
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist