Provider Demographics
NPI:1942359237
Name:EGAN, DAVID CLIFFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLIFFORD
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 1:2012 W 12 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3909
Mailing Address - Country:US
Mailing Address - Phone:248-545-8465
Mailing Address - Fax:
Practice Address - Street 1:999 HAYNES STREET
Practice Address - Street 2:SUITE #285
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6724
Practice Address - Country:US
Practice Address - Phone:248-540-3494
Practice Address - Fax:248-544-9198
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0132971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice