Provider Demographics
NPI:1881603918
Name:EGAN, ELIZABETH ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:EGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:EGAN LODGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:18 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1402
Mailing Address - Country:US
Mailing Address - Phone:609-259-3336
Mailing Address - Fax:609-259-1295
Practice Address - Street 1:18 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1402
Practice Address - Country:US
Practice Address - Phone:609-259-3336
Practice Address - Fax:609-259-1295
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI19819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDI19819OtherDENTAL LICENSE