Provider Demographics
NPI:1265512891
Name:EGAN, WILLIAM J (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
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 1:4500 PEWTER LN
Mailing Address - Street 2:BLDG. 6
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9707
Mailing Address - Country:US
Mailing Address - Phone:315-682-4314
Mailing Address - Fax:
Practice Address - Street 1:4500 PEWTER LN
Practice Address - Street 2:BLDG. 6
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9707
Practice Address - Country:US
Practice Address - Phone:315-682-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY227461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00601230Medicaid