Provider Demographics
NPI:1306849336
Name:TOWNSEND, ERIC L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SOLANA RD
Mailing Address - Street 2:STE A
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5229
Mailing Address - Country:US
Mailing Address - Phone:904-285-7711
Mailing Address - Fax:904-285-3604
Practice Address - Street 1:105 SOLANA RD
Practice Address - Street 2:STE A
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-5229
Practice Address - Country:US
Practice Address - Phone:904-285-7711
Practice Address - Fax:904-285-3604
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN106551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU29639Medicare UPIN