Healthcare Provider Details

I. General information

NPI: 1649283169
Provider Name (Legal Business Name): RODNEY J. ECCLES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 STAFFORD RD
PLAINFIELD IN
46168-2339
US

IV. Provider business mailing address

1858 STAFFORD RD
PLAINFIELD IN
46168-2339
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-4100
  • Fax: 317-839-7874
Mailing address:
  • Phone: 317-839-4100
  • Fax: 317-839-7874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008688
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: