Healthcare Provider Details

I. General information

NPI: 1104827708
Provider Name (Legal Business Name): ROBERT ALAN ECKELSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NW 13TH ST #3-B
BOCA RATON FL
33486-2337
US

IV. Provider business mailing address

951 NW 13TH ST STE 3B
BOCA RATON FL
33486-2337
US

V. Phone/Fax

Practice location:
  • Phone: 561-391-6415
  • Fax: 561-391-6415
Mailing address:
  • Phone: 561-495-8198
  • Fax: 561-391-6415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: