Provider Demographics
NPI:1891890299
Name:EGBERT, THOMAS A (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:EGBERT
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 1:4242 E SOUTHCROSS
Mailing Address - Street 2:#9
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3728
Mailing Address - Country:US
Mailing Address - Phone:210-333-4421
Mailing Address - Fax:210-333-4521
Practice Address - Street 1:4242 E SOUTHCROSS
Practice Address - Street 2:#9
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3728
Practice Address - Country:US
Practice Address - Phone:210-333-4421
Practice Address - Fax:210-333-4521
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB09308 1OtherCHIPS