Provider Demographics
NPI:1366584898
Name:EBERHARDT, AUGUST ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:AUGUST
Middle Name:ALAN
Last Name:EBERHARDT
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 1:748 MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-1308
Mailing Address - Country:US
Mailing Address - Phone:570-424-2445
Mailing Address - Fax:570-424-2276
Practice Address - Street 1:748 MILFORD RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1308
Practice Address - Country:US
Practice Address - Phone:570-424-2445
Practice Address - Fax:570-424-2276
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021067L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice