Provider Demographics
NPI:1598287898
Name:EGGART, EMILY (DDS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:EGGART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WINDING HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2249
Mailing Address - Country:US
Mailing Address - Phone:337-962-5325
Mailing Address - Fax:
Practice Address - Street 1:505 WOODBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7122
Practice Address - Country:US
Practice Address - Phone:972-442-3028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-09
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6801122300000X
TX338421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist