Healthcare Provider Details

I. General information

NPI: 1578971669
Provider Name (Legal Business Name): DONALD A. EBERHART, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14815 W BELL RD STE 202
SURPRISE AZ
85374-7611
US

IV. Provider business mailing address

14815 W BELL RD STE 202
SURPRISE AZ
85374-7611
US

V. Phone/Fax

Practice location:
  • Phone: 623-547-5400
  • Fax: 623-792-8734
Mailing address:
  • Phone: 623-547-5400
  • Fax: 623-792-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD A EBERHART
Title or Position: MEMBER
Credential: DDS
Phone: 623-547-5400