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General NPI Number Information
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NPI Number | 1144950445
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Entity Type | Individual
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Provider Name | ERIC REID DARNELL
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Gender | Male
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 511 ELSIE ST
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City | VAN BUREN
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State | MO
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Zip | 63965-7800
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Country | US
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Telephone | 573-323-4287
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Fax |
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Provider Business Mailing Address
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Address Line | 316 SHARONDALE DR
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City | EL PASO
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State | TX
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Zip | 79912-4250
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Country | US
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Telephone | 915-491-2354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D011380
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2024048189
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License Number State | MO
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