Provider Demographics
NPI:1225431307
Name:BRYCE R EAGAR DDS PLLC
Entity Type:Organization
Organization Name:BRYCE R EAGAR DDS PLLC
Other - Org Name:GATEWAY ORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-656-0507
Mailing Address - Street 1:720 S. RIVER RD STE B-210
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-656-0507
Mailing Address - Fax:435-656-3791
Practice Address - Street 1:720 S. RIVER RD. STE B-210
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-656-0507
Practice Address - Fax:435-656-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9052028-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental