Provider Demographics
NPI:1205873270
Name:BRIAN D EBERHART DDS PC
Entity type:Organization
Organization Name:BRIAN D EBERHART DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:EBERHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-258-4344
Mailing Address - Street 1:3650 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3114
Mailing Address - Country:US
Mailing Address - Phone:574-258-4344
Mailing Address - Fax:
Practice Address - Street 1:3650 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3114
Practice Address - Country:US
Practice Address - Phone:574-258-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty