Provider Demographics
NPI:1255534053
Name:EICHELMAN, CAROL RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:RENEE
Last Name:EICHELMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 PATUXENT OVERLOOK CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2250
Mailing Address - Country:US
Mailing Address - Phone:410-461-4160
Mailing Address - Fax:
Practice Address - Street 1:3444 ELLICOTT CENTER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4170
Practice Address - Country:US
Practice Address - Phone:410-461-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD82711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice