Provider Demographics
NPI:1306216114
Name:EL MASRI, ERIC WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:EL MASRI
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 1:323 MAPLE AVE
Mailing Address - Street 2:APT 19
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1608
Mailing Address - Country:US
Mailing Address - Phone:802-342-4633
Mailing Address - Fax:
Practice Address - Street 1:927 PUTNEY RD
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-9048
Practice Address - Country:US
Practice Address - Phone:802-342-4633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01601149691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice