Provider Demographics
NPI:1417021619
Name:SCHIFFMAN, ERIC LEO (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LEO
Last Name:SCHIFFMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 189S
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1052
Mailing Address - Country:US
Mailing Address - Phone:651-332-7474
Mailing Address - Fax:651-337-7475
Practice Address - Street 1:2550 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 189S
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1052
Practice Address - Country:US
Practice Address - Phone:651-332-7474
Practice Address - Fax:651-337-7475
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9513122300000X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN805320100Medicaid
MN3D805SCOtherBLUE CROSS
MN37604OtherPREFERRED ONE
MN43-41030OtherMEDICA
MN3D805SCOtherBLUE CROSS
MN43-41030OtherMEDICA