Provider Demographics
NPI:1093965857
Name:EGBERT, NICHOLAS LUKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:LUKE
Last Name:EGBERT
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 1:7535 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3812
Mailing Address - Country:US
Mailing Address - Phone:901-754-4200
Mailing Address - Fax:901-754-7511
Practice Address - Street 1:7535 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3812
Practice Address - Country:US
Practice Address - Phone:901-754-4200
Practice Address - Fax:901-754-7511
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000089221223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics