Provider Demographics
NPI:1164562450
Name:LA FAYETTE, ERIC HUDSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:HUDSON
Last Name:LA FAYETTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PELHAM RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-2733
Mailing Address - Country:US
Mailing Address - Phone:256-435-7735
Mailing Address - Fax:256-435-7735
Practice Address - Street 1:703 PELHAM RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-2733
Practice Address - Country:US
Practice Address - Phone:256-435-7735
Practice Address - Fax:256-435-7735
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist