Provider Demographics
NPI:1154512911
Name:CHRISTINE ECKEL DDS PC
Entity Type:Organization
Organization Name:CHRISTINE ECKEL DDS PC
Other - Org Name:WOODSTOCK FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STURN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-517-2688
Mailing Address - Street 1:10010 HIGHWAY 92
Mailing Address - Street 2:SUITE 140
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6427
Mailing Address - Country:US
Mailing Address - Phone:770-517-2688
Mailing Address - Fax:770-517-2860
Practice Address - Street 1:10010 HIGHWAY 92
Practice Address - Street 2:SUITE 140
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6427
Practice Address - Country:US
Practice Address - Phone:770-517-2688
Practice Address - Fax:770-517-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty