Provider Demographics
NPI:1659645539
Name:OAK FAMILY DENTISTRY
Entity Type:Organization
Organization Name:OAK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:EICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-385-7350
Mailing Address - Street 1:450 S CAMINO DEL RIO STE 207
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6857
Mailing Address - Country:US
Mailing Address - Phone:970-385-7350
Mailing Address - Fax:970-385-7597
Practice Address - Street 1:450 S CAMINO DEL RIO STE 207
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6857
Practice Address - Country:US
Practice Address - Phone:970-385-7350
Practice Address - Fax:970-385-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1062961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty