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General NPI Number Information
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NPI Number | 1205914322
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Entity Type | Individual
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Provider Name | IRA L EISENSTEIN DMD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1050 N KINGS HWY STE 104
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City | CHERRY HILL
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State | NJ
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Zip | 08034
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Country | US
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Telephone | 856-755-0992
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Fax | 856-755-1444
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Provider Business Mailing Address
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Address Line | 955 CHANTICLEER
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City | CHERRY HILL
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State | NJ
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Zip | 08003-4805
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Country | US
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Telephone | 856-424-1216
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22D101115000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DS018944L
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License Number State | PA
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