MEDICARE: LISA EICH DMD

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	1223G0001X	General Practice Dentistry	4488	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	51513228EIC	OTHER	AL	BLUE CROSS#-CENTRAL DENTA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	51513230	OTHER	AL	BLUE CROSS BLUE SHIELD WESTERN DENTAL
6	51548198	OTHER	AL	BLUE CROSS BLUE SHIELD EASTERN DENTAL
7	51513229EIC	OTHER	AL	BLUE CROSS#-BESSEMER DENT
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801977012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA EICH DMD

Provider Business Mailing Address
First Line	:	2201 ARLINGTON AVE
Second Line	:	JEFFERSON COUNTY HEALTH DEPT-BESSEMER DENTAL CLINIC
City	:	BIRMINGHAM
State	:	AL
Zip	:	35020
Country	:	US
Telephone Number	:	205-930-1422
Fax Number	:	205-930-1448

Provider Business Practice Location Address
First Line	:	2201 ARLINGTON AVE
Second Line	:	JEFFERSON COUNTY HEALTH DEPT-BESSEMER DENTAL CLINIC
City	:	BIRMINGHAM
State	:	AL
Zip	:	35020
Country	:	US
Telephone Number	:	205-930-1422
Fax Number	:	205-930-1448

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/04/2011

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Directions to “ LISA EICH DMD” Practice Location

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