Provider Demographics
NPI:1184620007
Name:ECKELS, DONALD V (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:V
Last Name:ECKELS
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 1:3300 EDINBOROUGH WAY
Mailing Address - Street 2:STE 203
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5958
Mailing Address - Country:US
Mailing Address - Phone:952-893-0400
Mailing Address - Fax:952-893-3840
Practice Address - Street 1:3300 EDINBOROUGH WAY
Practice Address - Street 2:STE 203
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5958
Practice Address - Country:US
Practice Address - Phone:952-893-0400
Practice Address - Fax:952-893-3840
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN03904ECOtherBLUE CROSS/BLUE SHIELD