Provider Demographics
NPI:1295205169
Name:EGGENBERGER, KAYLA RENEE (RDH)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEE
Last Name:EGGENBERGER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:RENEE
Other - Last Name:JANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:606 STATE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-2927
Mailing Address - Country:US
Mailing Address - Phone:719-640-2786
Mailing Address - Fax:
Practice Address - Street 1:4250 S CLEAR CREEK RD
Practice Address - Street 2:#213
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-285-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21540124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist