Provider Demographics
NPI:1699818831
Name:ECKHOFF, LISA M (RDH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ECKHOFF
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7465 GOLDEN OAK CT
Mailing Address - Street 2:
Mailing Address - City:MINNESOTA CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55959-1223
Mailing Address - Country:US
Mailing Address - Phone:507-429-9615
Mailing Address - Fax:
Practice Address - Street 1:245 W MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3720
Practice Address - Country:US
Practice Address - Phone:507-213-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH4574124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2966901011Medicaid