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Individual
DR. MICHAEL L. EISENBROCK
Active
Individual
DR. MICHAEL L. EISENBROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS019531L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103205
UNITED CONCORDIA PROVIDER
PA
01
—
232209954
TAX ID
PA
01
—
DS019531L
LICENSE NUMBER
PA
Enumeration date
11/14/2006
Last updated
04/12/2017
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