Provider Demographics
NPI:1972722163
Name:EISENBAND, MICHAEL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:EISENBAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3588
Mailing Address - Country:US
Mailing Address - Phone:561-364-2273
Mailing Address - Fax:561-364-2272
Practice Address - Street 1:6080 BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3588
Practice Address - Country:US
Practice Address - Phone:561-364-2273
Practice Address - Fax:561-364-2272
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201260599OtherTAX ID NUMBER