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General NPI Number Information
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NPI Number | 1508612300
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Entity Type | Organization
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Legal Business Name | ERIC LAFAYETTE D.M.D LLC
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Dates
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Enumeration Date | 04/24/2024
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 703 PELHAM RD S
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City | JACKSONVILLE
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State | AL
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Zip | 36265-2733
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Country | US
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Telephone | 256-435-6193
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Fax |
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Provider Business Mailing Address
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Address Line | 703 PELHAM RD S
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City | JACKSONVILLE
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State | AL
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Zip | 36265-2733
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Country | US
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Telephone | 256-435-6193
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Fax | 256-435-7735
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Authorized Official
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Title or Position | OWNER
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Name | ERIC HUDSON LAFAYETTE
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Credential | D.M.D
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Telephone | 256-435-6193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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