Provider Demographics
NPI:1861519522
Name:VEAL, ERIC T (DMD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:VEAL
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 1:8013 NEW LAGRANGE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4700
Mailing Address - Country:US
Mailing Address - Phone:502-425-7068
Mailing Address - Fax:502-426-3493
Practice Address - Street 1:8013 NEW LAGRANGE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4700
Practice Address - Country:US
Practice Address - Phone:502-425-7068
Practice Address - Fax:502-426-3493
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY72071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice