Provider Demographics
NPI:1629366281
Name:EGLOFF, TONYA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:LYNN
Last Name:EGLOFF
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 1:2211 MIDWESTERN PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2300
Mailing Address - Country:US
Mailing Address - Phone:940-692-0321
Mailing Address - Fax:940-696-5039
Practice Address - Street 1:2211 MIDWESTERN PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2300
Practice Address - Country:US
Practice Address - Phone:940-692-0321
Practice Address - Fax:940-696-5039
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice