Healthcare Provider Details

I. General information

NPI: 1417021619
Provider Name (Legal Business Name): ERIC LEO SCHIFFMAN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W SUITE 189S
SAINT PAUL MN
55114-1052
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W SUITE 189S
SAINT PAUL MN
55114-1052
US

V. Phone/Fax

Practice location:
  • Phone: 651-332-7474
  • Fax: 651-337-7475
Mailing address:
  • Phone: 651-332-7474
  • Fax: 651-337-7475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD9513
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberD9513
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: