Provider Demographics
NPI:1134335979
Name:GOTLIEB, ERIC LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LEE
Last Name:GOTLIEB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 T J GAMESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5821
Mailing Address - Country:US
Mailing Address - Phone:603-501-0027
Mailing Address - Fax:
Practice Address - Street 1:18 HAMPTON RD
Practice Address - Street 2:SUITE 5
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4871
Practice Address - Country:US
Practice Address - Phone:603-775-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics