MEDICARE: DR. ERIC CHARLES ECKMAN 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	1223G0001X	General Practice Dentistry	12008570	IN

General Provider Information

NPI Number	:	1912618653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC CHARLES ECKMAN DDS

Provider Business Mailing Address
First Line	:	8825 JAYWICK DR APT 206
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-8668
Country	:	US
Telephone Number	:	317-340-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	6202 BROADWAY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1837
Country	:	US
Telephone Number	:	317-340-8700
Fax Number	:

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

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/13/2022

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