Provider Demographics
NPI:1215376652
Name:EUDALY, ERIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:EUDALY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 US HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1732
Mailing Address - Country:US
Mailing Address - Phone:901-872-3391
Mailing Address - Fax:
Practice Address - Street 1:8020 US HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1732
Practice Address - Country:US
Practice Address - Phone:901-872-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice