Provider Demographics
NPI:1003825589
Name:GARY R EGGLER DMD PC
Entity Type:Organization
Organization Name:GARY R EGGLER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:EGGLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-349-9220
Mailing Address - Street 1:850 HOSPITAL ROAD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-349-9220
Mailing Address - Fax:724-349-9221
Practice Address - Street 1:850 HOSPITAL ROAD
Practice Address - Street 2:SUITE 1100
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-349-9220
Practice Address - Fax:724-349-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020691L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T28296Medicare UPIN