Healthcare Provider Details

I. General information

NPI: 1134204258
Provider Name (Legal Business Name): ERIC B. VANHUSS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6842 MORRISON BLVD SUITE 200
CHARLOTTE NC
28211-3547
US

IV. Provider business mailing address

6842 MORRISON BLVD SUITE 200
CHARLOTTE NC
28211-3547
US

V. Phone/Fax

Practice location:
  • Phone: 704-362-4095
  • Fax: 704-362-4099
Mailing address:
  • Phone: 704-362-4095
  • Fax: 704-362-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3729
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: