Basic Information
Provider Information
NPI: 1033556386
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EBY
FirstName: JEFFREY
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: D.M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 240 N 7TH ST
Address2: SUITE 400
City: AKRON
State: PA
PostalCode: 175011361
CountryCode: US
TelephoneNumber: 7178594170
FaxNumber: 7178594174
Practice Location
Address1: 240 N 7TH ST
Address2: SUITE 400
City: AKRON
State: PA
PostalCode: 175011361
CountryCode: US
TelephoneNumber: 7178594170
FaxNumber: 7178594174
Other Information
ProviderEnumerationDate: 05/28/2013
LastUpdateDate: 05/28/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDS030794LPAY Dental ProvidersDentist 

No ID Information.


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