Provider Demographics
NPI:1982097911
Name:DOCTOR JAMES E. EASH, D.D.S., P.C.
Entity Type:Organization
Organization Name:DOCTOR JAMES E. EASH, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:EASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-897-1410
Mailing Address - Street 1:911 AIGNER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601
Mailing Address - Country:US
Mailing Address - Phone:812-897-1410
Mailing Address - Fax:812-897-1464
Practice Address - Street 1:911 AIGNER DRIVE
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601
Practice Address - Country:US
Practice Address - Phone:812-897-1410
Practice Address - Fax:812-897-1464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTOR JAMES E. EASH, D.D.S., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008687A302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100238920Medicaid