Provider Demographics
NPI:1013350057
Name:EGGLER, GARY ROSS (DMD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ROSS
Last Name:EGGLER
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 1:850 HOSPITAL RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3662
Mailing Address - Country:US
Mailing Address - Phone:724-349-9220
Mailing Address - Fax:724-349-9221
Practice Address - Street 1:850 HOSPITAL RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3662
Practice Address - Country:US
Practice Address - Phone:724-349-9220
Practice Address - Fax:724-349-9221
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020691L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
T28296Medicare UPIN