Provider Demographics
NPI:1770721037
Name:EGGLESTON, TERRY LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 MISSION CIR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5398
Mailing Address - Country:US
Mailing Address - Phone:707-538-7600
Mailing Address - Fax:707-538-7696
Practice Address - Street 1:55 MISSION CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5398
Practice Address - Country:US
Practice Address - Phone:707-538-7600
Practice Address - Fax:707-538-7696
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA300671223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics