Provider Demographics
NPI:1427206523
Name:EICHHORN, CHANTELLE LEE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:CHANTELLE
Middle Name:LEE
Last Name:EICHHORN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N14502 EKBERG RD L5
Mailing Address - Street 2:
Mailing Address - City:POWERS
Mailing Address - State:MI
Mailing Address - Zip Code:49874
Mailing Address - Country:US
Mailing Address - Phone:906-259-1262
Mailing Address - Fax:
Practice Address - Street 1:N14502 EKBERG RD
Practice Address - Street 2:
Practice Address - City:POWERS
Practice Address - State:MI
Practice Address - Zip Code:49874
Practice Address - Country:US
Practice Address - Phone:906-295-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902013280124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist