Provider Demographics
NPI:1336300847
Name:UNKENHOLZ, ERIC GRANT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:GRANT
Last Name:UNKENHOLZ
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 1:710 MOUNT RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3609
Mailing Address - Country:US
Mailing Address - Phone:605-399-9000
Mailing Address - Fax:605-399-9008
Practice Address - Street 1:710 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3609
Practice Address - Country:US
Practice Address - Phone:605-399-9000
Practice Address - Fax:605-399-9008
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD08251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice