Provider Demographics
NPI:1043215031
Name:EAGLE, HOWARD GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:GLENN
Last Name:EAGLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8896 HAMPE CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4457
Mailing Address - Country:US
Mailing Address - Phone:858-538-4805
Mailing Address - Fax:
Practice Address - Street 1:333 H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5555
Practice Address - Country:US
Practice Address - Phone:619-426-7582
Practice Address - Fax:619-781-9062
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439431223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics