Provider Demographics
NPI:1144353467
Name:ECKSTEIN, E CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:E
Middle Name:CHARLES
Last Name:ECKSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231
Mailing Address - Country:US
Mailing Address - Phone:716-204-4999
Mailing Address - Fax:716-623-2963
Practice Address - Street 1:435 W COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1010
Practice Address - Country:US
Practice Address - Phone:260-969-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02985501122300000X
NJ9282122300000X
PADS035365122300000X
VT016 0002137122300000X
IN12010964A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist