Provider Demographics
NPI:1427190834
Name:EGGER, JEFFERY J (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:J
Last Name:EGGER
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1522
Mailing Address - Country:US
Mailing Address - Phone:503-284-2893
Mailing Address - Fax:503-287-2016
Practice Address - Street 1:2111 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1522
Practice Address - Country:US
Practice Address - Phone:503-284-2893
Practice Address - Fax:503-287-2016
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR59511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice