Provider Demographics
NPI:1881791036
Name:EGAN, ROGER KENT (DMD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KENT
Last Name:EGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4702
Mailing Address - Country:US
Mailing Address - Phone:503-472-6182
Mailing Address - Fax:503-472-8366
Practice Address - Street 1:325 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4702
Practice Address - Country:US
Practice Address - Phone:503-472-6182
Practice Address - Fax:503-472-8366
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD4931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist