Provider Demographics
NPI:1962015347
Name:ERIC D FORD DDS PLLC
Entity Type:Organization
Organization Name:ERIC D FORD DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-523-3296
Mailing Address - Street 1:422 KINETIC DR STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-5268
Mailing Address - Country:US
Mailing Address - Phone:304-523-3296
Mailing Address - Fax:304-523-6269
Practice Address - Street 1:422 KINETIC DR STE A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-5268
Practice Address - Country:US
Practice Address - Phone:304-523-3296
Practice Address - Fax:304-523-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty