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General NPI Number Information
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NPI Number | 1568082493
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Entity Type | Individual
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Provider Name | NICHOLE ECKRICH
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Gender | Female
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 320 EAST HOSPITAL ROAD BUILDING 320, ROOM A102
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City | FORT GORDON
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State | GA
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Zip | 30905
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Country | US
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Telephone | 706-787-6927
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Fax |
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Provider Business Mailing Address
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Address Line | 5511 SHOOTING STAR TRL
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City | RAPID CITY
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State | SD
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Zip | 57702-8867
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Country | US
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Telephone | 605-430-4486
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 13396331-9926
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13396331-9926
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License Number State | UT
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