Provider Demographics
NPI:1437561230
Name:EISENRICH, TARA KRISTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:KRISTIN
Last Name:EISENRICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 CULEBRA RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1477
Mailing Address - Country:US
Mailing Address - Phone:210-523-0000
Mailing Address - Fax:
Practice Address - Street 1:7614 CULEBRA RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1477
Practice Address - Country:US
Practice Address - Phone:210-523-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice