Provider Demographics
NPI:1790911014
Name:EGAN, KATHRYN RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:RAE
Last Name:EGAN
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 1:5150 PRESCHOOL LANE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-551-3373
Mailing Address - Fax:
Practice Address - Street 1:5150 PRESCHOOL LANE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3734
Practice Address - Country:US
Practice Address - Phone:423-551-3373
Practice Address - Fax:423-551-3378
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1333122300000X
TN9373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist