Provider Demographics
NPI:1902824741
Name:EILAND, EDWARD H JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:EILAND
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:H
Other - Last Name:EILAND
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS,LTD
Mailing Address - Street 1:206 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-3100
Mailing Address - Country:US
Mailing Address - Phone:318-878-2411
Mailing Address - Fax:318-878-2414
Practice Address - Street 1:206 NEVADA ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-3100
Practice Address - Country:US
Practice Address - Phone:318-878-2411
Practice Address - Fax:318-878-2414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 22791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1822795Medicaid
LA2279LAOtherDELTA DENTAL OF CALIFORNI