Eric James Etheridge, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2010016169 Issued in MO

Practice address

10800 E 77TH Ter
Raytown, MO 64138-2331

Phone

(816) 358-1122

Fax

(816) 358-7853

NPI assigned

Jul 26, 2010

Last updated

Sep 15, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Terrace Family Dentistry LLC

  • General Practice Dentistry
  • Raytown, MO
  • NPI 1346111986
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410739200000",
    "number": "1881907343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 E 77TH TER",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641382331",
            "telephone_number": "816-358-1122",
            "fax_number": "816-358-7853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 E 77TH TER",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641382331",
            "telephone_number": "816-358-1122",
            "fax_number": "816-358-7853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "ERIC",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-26",
        "last_updated": "2014-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2010016169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Eitel, NP
• Elite Healthcare, LLC
• Emily Katherine Handley, DDS, PC (Raytown Dental Care)
• Chrishawn Estes, MSN-ED, RNC-CBC
• Kartapurkh Estlund
• Eunique Child Care
• Everyday Home Health Care
• Amie Fabah
• Faith's Haven Center Inc.
• Lonnie T Feagan, DDS

• Dentist in Raytown, MO
• Providers in Raytown, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.