Provider Demographics
NPI:1376631986
Name:ESHELMAN, MICHAEL BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:ESHELMAN
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 1:1017 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5525
Mailing Address - Country:US
Mailing Address - Phone:281-255-4647
Mailing Address - Fax:281-255-4706
Practice Address - Street 1:1017 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5525
Practice Address - Country:US
Practice Address - Phone:281-255-4647
Practice Address - Fax:281-255-4706
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134531223X0400X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice