Provider Demographics
NPI:1679231286
Name:CAMPUS LANE DENTAL PLLC
Entity type:Organization
Organization Name:CAMPUS LANE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHENLAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-515-2949
Mailing Address - Street 1:5 CAMPUS LN
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1429
Mailing Address - Country:US
Mailing Address - Phone:617-515-2949
Mailing Address - Fax:413-527-1242
Practice Address - Street 1:5 CAMPUS LN
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1429
Practice Address - Country:US
Practice Address - Phone:617-515-2949
Practice Address - Fax:413-527-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental