Provider Demographics
NPI:1184825267
Name:EICON DENTAL, LLC
Entity Type:Organization
Organization Name:EICON DENTAL, LLC
Other - Org Name:EICON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:EICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-921-2434
Mailing Address - Street 1:2210 S MILL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2153
Mailing Address - Country:US
Mailing Address - Phone:480-921-2434
Mailing Address - Fax:480-921-2624
Practice Address - Street 1:2210 S MILL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2153
Practice Address - Country:US
Practice Address - Phone:480-921-2434
Practice Address - Fax:480-921-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty