Provider Demographics
NPI:1710391123
Name:ECKARD, AUSTIN DANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DANIEL
Last Name:ECKARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 STRATHMORE WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5488
Mailing Address - Country:US
Mailing Address - Phone:951-813-9676
Mailing Address - Fax:
Practice Address - Street 1:9323 LAGUNA SPRINGS DR STE 100
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7839
Practice Address - Country:US
Practice Address - Phone:916-689-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA634341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery