Provider Demographics
NPI:1760530901
Name:EICHSTAEDT, RALPH MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:MARK
Last Name:EICHSTAEDT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2033 20TH AVENUE PKWY
Mailing Address - Street 2:
Mailing Address - City:INDIAN ROCKS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33785-2971
Mailing Address - Country:US
Mailing Address - Phone:407-405-4030
Mailing Address - Fax:
Practice Address - Street 1:1060 W BUSCH BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7707
Practice Address - Country:US
Practice Address - Phone:813-931-4000
Practice Address - Fax:813-935-6532
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery