Provider Demographics
NPI:1598970279
Name:EADS, CLEVE RONALD (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLEVE
Middle Name:RONALD
Last Name:EADS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12K MAJESTY WAY
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-3160
Mailing Address - Country:US
Mailing Address - Phone:518-859-7795
Mailing Address - Fax:
Practice Address - Street 1:286 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-9208
Practice Address - Country:US
Practice Address - Phone:518-584-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD91271223G0001X
NY044287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice