1447529946 NPI number — EDWARD H EILAND JR DDS LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447529946 NPI number — EDWARD H EILAND JR DDS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD H EILAND JR DDS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447529946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 511
Provider Second Line Business Mailing Address:
206 NEVADA AVENUE
Provider Business Mailing Address City Name:
DELHI
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71232-0511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-878-2411
Provider Business Mailing Address Fax Number:
318-878-2414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 NEVADA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELHI
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71232-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-878-2411
Provider Business Practice Location Address Fax Number:
318-878-2414
Provider Enumeration Date:
12/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
EILAND
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-878-2411

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  LA 2279 LA , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1822795 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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