Provider Demographics
NPI:1982692174
Name:EISNER, JEFFREY MARC (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARC
Last Name:EISNER
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 1:11020 N KENDALL DR STE 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1217
Mailing Address - Country:US
Mailing Address - Phone:305-279-8600
Mailing Address - Fax:305-279-6918
Practice Address - Street 1:11020 N KENDALL DR STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1217
Practice Address - Country:US
Practice Address - Phone:305-279-8600
Practice Address - Fax:305-279-6918
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8851204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T87880Medicare UPIN
66500Medicare ID - Type Unspecified