Andrea Eicker, DMD
Individual provider Active NPI Dentist · Cuba, NM
NPI 1780946434 · NPPES record last updated Jun 25, 2014
Key facts
- NPI
- 1780946434
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DD4039 (NM)
- Practice address
- 6349 US Highway 550
Cuba, NM 87013 - Phone
- (575) 289-3291
- NPI assigned
- Jun 8, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160406000808 | NM | Order and Referring Only - Dentist |
7618275751 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD4039 | NM | MD | Dentist |
| D008438 | AZ | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D008438 | AZ | |
| Dentist | 122300000X | DD4039 | NM | Yes |
Addresses
Primary practice location
6349 US Highway 550
Cuba, NM 87013
Mailing address
6349 US Highway 550
Cuba, NM 87013
Phone (575) 289-3291
Other providers in Cuba, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.