Provider Demographics
NPI:1710034731
Name:EGAN, MICHAEL DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DENNIS
Last Name:EGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16345 S. HARLEM AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477
Mailing Address - Country:US
Mailing Address - Phone:708-971-4696
Mailing Address - Fax:708-620-8219
Practice Address - Street 1:16345 S. HARLEM AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477
Practice Address - Country:US
Practice Address - Phone:708-971-4696
Practice Address - Fax:708-620-8219
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190230361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice