=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790993582
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN DAVID EHRMAN D.D.S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 08/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2914 BETIN AVE
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71201-7258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-323-4450
-----------------------------------------------------
Fax | 318-323-4430
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 MONTELEON CIR
-----------------------------------------------------
City | WEST MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71291-4737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-386-5843
-----------------------------------------------------
Fax | 740-387-1384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 18754
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 7485
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------