Provider Demographics
NPI:1891836821
Name:EISENBERG, STANLEY ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ROSS
Last Name:EISENBERG
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 1:2706 CLAIRMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2713
Mailing Address - Country:US
Mailing Address - Phone:404-633-9663
Mailing Address - Fax:404-633-2411
Practice Address - Street 1:2706 CLAIRMONT RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2713
Practice Address - Country:US
Practice Address - Phone:404-633-9663
Practice Address - Fax:404-633-2411
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice