Provider Demographics
NPI:1225088065
Name:DANA, ERICA EBERLEIN (DMD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:EBERLEIN
Last Name:DANA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 NARROWS DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8627
Mailing Address - Country:US
Mailing Address - Phone:205-408-8889
Mailing Address - Fax:
Practice Address - Street 1:141 NARROWS DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8627
Practice Address - Country:US
Practice Address - Phone:205-408-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630410136Medicaid
AL630408136Medicaid
AL630412136Medicaid