Provider Demographics
NPI:1316063803
Name:KENNETH L EGGER JR DDS PC
Entity type:Organization
Organization Name:KENNETH L EGGER JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:EGGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-773-3560
Mailing Address - Street 1:900 E BELLOWS ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3904
Mailing Address - Country:US
Mailing Address - Phone:989-773-3560
Mailing Address - Fax:989-773-9081
Practice Address - Street 1:900 E BELLOWS ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3904
Practice Address - Country:US
Practice Address - Phone:989-773-3560
Practice Address - Fax:989-773-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty