Provider Demographics
NPI:1760539852
Name:EAKER, GWEN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:GWEN
Middle Name:C
Last Name:EAKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 CREEKSIDE PARK SUITE #102
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070
Mailing Address - Country:US
Mailing Address - Phone:830-438-2121
Mailing Address - Fax:830-438-5191
Practice Address - Street 1:172 CREEKSIDE PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6221
Practice Address - Country:US
Practice Address - Phone:830-438-2121
Practice Address - Fax:830-438-5191
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA25-18523001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice