Provider Demographics
NPI:1720380207
Name:BELLEAIR ORAL SURGERY AND IMPLANTS, PLLC
Entity Type:Organization
Organization Name:BELLEAIR ORAL SURGERY AND IMPLANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:EICHSTAEDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-581-3300
Mailing Address - Street 1:100 INDIAN ROCKS RD N
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BELLEAIR BLUFFS
Mailing Address - State:FL
Mailing Address - Zip Code:33770-1778
Mailing Address - Country:US
Mailing Address - Phone:727-581-3300
Mailing Address - Fax:727-581-3302
Practice Address - Street 1:100 INDIAN ROCKS RD N
Practice Address - Street 2:SUITE 12
Practice Address - City:BELLEAIR BLUFFS
Practice Address - State:FL
Practice Address - Zip Code:33770-1778
Practice Address - Country:US
Practice Address - Phone:727-581-3300
Practice Address - Fax:727-581-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty