Provider Demographics
NPI:1417397365
Name:ALLISON C. EGGLESTON, DDS, PC
Entity Type:Organization
Organization Name:ALLISON C. EGGLESTON, DDS, PC
Other - Org Name:DR. EGG PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:CAVENAUGH
Authorized Official - Last Name:EGGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:910-520-3319
Mailing Address - Street 1:6781 PARKER FARM DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3160
Mailing Address - Country:US
Mailing Address - Phone:910-795-2511
Mailing Address - Fax:910-679-4835
Practice Address - Street 1:6781 PARKER FARM DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3160
Practice Address - Country:US
Practice Address - Phone:910-795-2511
Practice Address - Fax:910-679-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8836261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921214Medicaid
NC1285863266OtherINDIVIDUAL NPI