Healthcare Provider Details

I. General information

NPI: 1598704702
Provider Name (Legal Business Name): DAVID LOUIS EIDELMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 MORRIS AVE
SPRINGFIELD NJ
07081-1005
US

IV. Provider business mailing address

475 MORRIS AVE
SPRINGFIELD NJ
07081-1005
US

V. Phone/Fax

Practice location:
  • Phone: 973-376-1144
  • Fax: 973-376-7339
Mailing address:
  • Phone: 973-376-1144
  • Fax: 973-376-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8886
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: