Provider Demographics
NPI:1174638746
Name:HOTZE, ERIC ROBERT (DMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ROBERT
Last Name:HOTZE
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 1:6312 HAZELWEST CT
Mailing Address - Street 2:SUITE #100
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042
Mailing Address - Country:US
Mailing Address - Phone:314-731-1200
Mailing Address - Fax:314-731-2630
Practice Address - Street 1:6312 HAZELWEST CT
Practice Address - Street 2:SUITE #100
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042
Practice Address - Country:US
Practice Address - Phone:314-731-1200
Practice Address - Fax:314-731-2630
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0141981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice