| NPI | 1083018840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY WAYNE EGGLESTON Owner 563-209-9041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: IA 08284) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: IA 09095) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2014-10-22 |