Provider Demographics
NPI:1114936754
Name:EGGER, KENNETH LEON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LEON
Last Name:EGGER
Suffix:JR
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 1:900 E BELLOWS ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3904
Mailing Address - Country:US
Mailing Address - Phone:989-773-3560
Mailing Address - Fax:989-773-9081
Practice Address - Street 1:900 E BELLOWS ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3904
Practice Address - Country:US
Practice Address - Phone:989-773-3560
Practice Address - Fax:989-773-9081
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice