Provider Demographics
NPI:1801385778
Name:LINES, ERIC GREGGORY
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:GREGGORY
Last Name:LINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 S AVENUE 8 E STE 4
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-8162
Mailing Address - Country:US
Mailing Address - Phone:928-344-3177
Mailing Address - Fax:
Practice Address - Street 1:3325 S AVENUE 8 E STE 4
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-8162
Practice Address - Country:US
Practice Address - Phone:928-344-3177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0100701223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice