Provider Demographics
NPI:1487645602
Name:LERNOR, ERIC WARREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WARREN
Last Name:LERNOR
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 1:4910 E GREENWAY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1653
Mailing Address - Country:US
Mailing Address - Phone:602-485-4747
Mailing Address - Fax:602-485-0123
Practice Address - Street 1:4910 E GREENWAY RD STE 6
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:602-485-4747
Practice Address - Fax:602-485-0123
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
481298975OtherEIN