Provider Demographics
NPI:1205914322
Name:EISENSTEIN, IRA L (DMD)
Entity type:Individual
Prefix:MR
First Name:IRA
Middle Name:L
Last Name:EISENSTEIN
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 1:955 CHANTICLEER
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-4805
Mailing Address - Country:US
Mailing Address - Phone:856-424-1216
Mailing Address - Fax:
Practice Address - Street 1:1050 N KINGS HWY
Practice Address - Street 2:STE 104
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:856-755-0992
Practice Address - Fax:856-755-1444
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1011150001223P0300X
PADS018944L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics