Provider Demographics
NPI:1720765704
Name:EKLIN, ERICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:
Last Name:EKLIN
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 1:910 SCRUPLE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-9525
Mailing Address - Country:US
Mailing Address - Phone:708-912-1281
Mailing Address - Fax:
Practice Address - Street 1:910 SCRUPLE WAY
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-9525
Practice Address - Country:US
Practice Address - Phone:708-912-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist