Provider Demographics
NPI:1932361094
Name:VONDENSTEIN, ERIC NATHANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:NATHANIEL
Last Name:VONDENSTEIN
Suffix:
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 1:119 ONYX ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5753
Mailing Address - Country:US
Mailing Address - Phone:337-257-7695
Mailing Address - Fax:
Practice Address - Street 1:1602 W PINHOOK RD
Practice Address - Street 2:SUITE 303
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3735
Practice Address - Country:US
Practice Address - Phone:337-235-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist