Healthcare Provider Details

I. General information

NPI: 1063462869
Provider Name (Legal Business Name): THOMAS A ESCHENROEDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 HUGUENOT RD SUITE 120
MIDLOTHIAN VA
23113-5604
US

IV. Provider business mailing address

PO BOX 71930
RICHMOND VA
23255-1930
US

V. Phone/Fax

Practice location:
  • Phone: 804-354-1600
  • Fax: 804-354-1607
Mailing address:
  • Phone: 804-354-1600
  • Fax: 804-354-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401006867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: