Provider Demographics
NPI:1295736569
Name:EILERS, CARL W JR (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:W
Last Name:EILERS
Suffix:JR
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 1:508 PRINCETON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:508 PRINCETON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2060
Practice Address - Country:US
Practice Address - Phone:423-915-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS77511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1609878388OtherORGANIZATION NPI
TN3726194OtherMEDICARE GROUP NUMBER
TN1518969229OtherORGANIZATION NPI NUMBER
TN1972504389OtherORGANIZATION NPI
TNV01458Medicare UPIN
TN1609878388OtherORGANIZATION NPI