Provider Demographics
NPI:1710137179
Name:PETER B. ECKEL DMD
Entity Type:Organization
Organization Name:PETER B. ECKEL DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-524-7455
Mailing Address - Street 1:PO BOX 7368
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-7368
Mailing Address - Country:US
Mailing Address - Phone:603-524-7455
Mailing Address - Fax:
Practice Address - Street 1:25 COUNTRY CLUB RD
Practice Address - Street 2:301 VILLAGE WEST
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6972
Practice Address - Country:US
Practice Address - Phone:603-524-7455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0201841YONHO1OtherANTHEM BC/BS FED#
NH89191841Medicaid