Provider Demographics
NPI:1962855908
Name:EICHBLATT, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:EICHBLATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 HILLSIDE OAK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-3673
Mailing Address - Country:US
Mailing Address - Phone:832-647-6564
Mailing Address - Fax:
Practice Address - Street 1:1015 W MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 1600
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4052
Practice Address - Country:US
Practice Address - Phone:281-338-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist