MEDICARE: DR. RALPH MARK EICHSTAEDT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN15139	FL

General Provider Information

NPI Number	:	1760530901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH MARK EICHSTAEDT DDS

Provider Business Mailing Address
First Line	:	2033 20TH AVENUE PKWY
Second Line	:
City	:	INDIAN ROCKS BEACH
State	:	FL
Zip	:	33785-2971
Country	:	US
Telephone Number	:	407-405-4030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 W BUSCH BLVD
Second Line	:	SUITE 105
City	:	TAMPA
State	:	FL
Zip	:	33612-7707
Country	:	US
Telephone Number	:	813-931-4000
Fax Number	:	813-935-6532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	07/08/2007

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