Provider Demographics
NPI:1801823216
Name:EGGLESTON, TODD IVAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:IVAN
Last Name:EGGLESTON
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:1801 N LAMAR BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1056
Mailing Address - Country:US
Mailing Address - Phone:512-391-0011
Mailing Address - Fax:512-391-0031
Practice Address - Street 1:1801 N LAMAR BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1056
Practice Address - Country:US
Practice Address - Phone:512-391-0011
Practice Address - Fax:512-391-0031
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX164201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV03345Medicare UPIN