Provider Demographics
NPI:1881905610
Name:EGGERT, JEFFREY M (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:EGGERT
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 1:700 VILLAGE CENTER DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-3019
Mailing Address - Country:US
Mailing Address - Phone:651-482-8412
Mailing Address - Fax:651-482-8376
Practice Address - Street 1:700 VILLAGE CENTER DR
Practice Address - Street 2:SUITE 160
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-3019
Practice Address - Country:US
Practice Address - Phone:651-482-8412
Practice Address - Fax:651-482-8376
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND128111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice