Provider Demographics
NPI:1508612300
Name:ERIC LAFAYETTE D.M.D LLC
Entity Type:Organization
Organization Name:ERIC LAFAYETTE D.M.D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:HUDSON
Authorized Official - Last Name:LAFAYETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-435-6193
Mailing Address - Street 1:703 PELHAM RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-2733
Mailing Address - Country:US
Mailing Address - Phone:256-435-6193
Mailing Address - Fax:256-435-7735
Practice Address - Street 1:703 PELHAM RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-2733
Practice Address - Country:US
Practice Address - Phone:256-435-6193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental