Provider Demographics
NPI:1578894366
Name:DAN ECKMANN DDS, INC
Entity Type:Organization
Organization Name:DAN ECKMANN DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-243-4434
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-0245
Mailing Address - Country:US
Mailing Address - Phone:320-243-4434
Mailing Address - Fax:320-243-4456
Practice Address - Street 1:106 E JAMES ST
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1615
Practice Address - Country:US
Practice Address - Phone:320-243-4434
Practice Address - Fax:320-243-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty