Provider Demographics
NPI:1174949549
Name:R HENRY ESHAM II DMD, PC
Entity type:Organization
Organization Name:R HENRY ESHAM II DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:ESHAM
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-343-0501
Mailing Address - Street 1:703 BISHOP LN N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-5838
Mailing Address - Country:US
Mailing Address - Phone:251-343-0501
Mailing Address - Fax:
Practice Address - Street 1:703 BISHOP LN N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5838
Practice Address - Country:US
Practice Address - Phone:251-343-0501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL60361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty