Provider Demographics
NPI:1942556105
Name:EEKHOFF, MOLLY A (LD)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:A
Last Name:EEKHOFF
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 ADAMS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2253
Mailing Address - Country:US
Mailing Address - Phone:541-624-5550
Mailing Address - Fax:
Practice Address - Street 1:808 ADAMS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2253
Practice Address - Country:US
Practice Address - Phone:541-624-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-10126244122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist