Provider Demographics
NPI:1689781585
Name:EISSENS, JEREMIAH D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:D
Last Name:EISSENS
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 1:1505 S GLENBURNIE RD STE J
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2632
Mailing Address - Country:US
Mailing Address - Phone:252-672-4404
Mailing Address - Fax:252-672-4402
Practice Address - Street 1:1505 S GLENBURNIE RD STE J
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2632
Practice Address - Country:US
Practice Address - Phone:252-672-4404
Practice Address - Fax:252-672-4402
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909169Medicaid