Provider Demographics
NPI:1891907044
Name:EGGLESTON, SHAWNDA J (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNDA
Middle Name:J
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 S. D STREET
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822
Mailing Address - Country:US
Mailing Address - Phone:308-872-2553
Mailing Address - Fax:
Practice Address - Street 1:401 5TH STREET
Practice Address - Street 2:
Practice Address - City:OVERTON
Practice Address - State:NE
Practice Address - Zip Code:68863-0264
Practice Address - Country:US
Practice Address - Phone:308-987-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1504124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist