Provider Demographics
NPI:1801977012
Name:EICH, LISA (DMD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:EICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 ARLINGTON AVE
Mailing Address - Street 2:JEFFERSON COUNTY HEALTH DEPT-BESSEMER DENTAL CLINIC
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35020
Mailing Address - Country:US
Mailing Address - Phone:205-930-1422
Mailing Address - Fax:205-930-1448
Practice Address - Street 1:2201 ARLINGTON AVE
Practice Address - Street 2:JEFFERSON COUNTY HEALTH DEPT-BESSEMER DENTAL CLINIC
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35020
Practice Address - Country:US
Practice Address - Phone:205-930-1422
Practice Address - Fax:205-930-1448
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934365Medicaid
AL51513228EICOtherBLUE CROSS#-CENTRAL DENTA
AL009934375Medicaid
AL009934385Medicaid
AL51513230OtherBLUE CROSS BLUE SHIELD WESTERN DENTAL
AL51548198OtherBLUE CROSS BLUE SHIELD EASTERN DENTAL
AL51513229EICOtherBLUE CROSS#-BESSEMER DENT
AL009934355Medicaid
AL51513230OtherBLUE CROSS BLUE SHIELD WESTERN DENTAL