Provider Demographics
NPI:1164439881
Name:EBY, ERIC LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LEE
Last Name:EBY
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 1:1085 WILLIAMSBURG CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9080
Mailing Address - Country:US
Mailing Address - Phone:517-655-5990
Mailing Address - Fax:
Practice Address - Street 1:2280 SOWER BLVD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3264
Practice Address - Country:US
Practice Address - Phone:517-349-9860
Practice Address - Fax:517-349-9862
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010175391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice