MEDICARE: MR. JOHN LEE EICHELBERGER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30017652	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30017652	OTHER	OH	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538271705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN LEE EICHELBERGER DDS

Provider Business Mailing Address
First Line	:	2345 EAST HIGH STREET
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-1321
Country	:	US
Telephone Number	:	933-732-2017
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 EAST HIGH STREET
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-1321
Country	:	US
Telephone Number	:	933-732-2017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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