Provider Demographics
NPI:1699840959
Name:ELTZROTH, ERIC LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LEE
Last Name:ELTZROTH
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 1:236 LOTO ST UNIT 1065
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-0860
Mailing Address - Country:US
Mailing Address - Phone:530-966-1284
Mailing Address - Fax:
Practice Address - Street 1:217 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-0450
Practice Address - Country:US
Practice Address - Phone:541-837-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508681223G0001X
ORD110011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice