Provider Demographics
NPI:1316954159
Name:EGGER, GRAHAM TATE (DDS)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:TATE
Last Name:EGGER
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 1:4000 BROWN TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3942
Mailing Address - Country:US
Mailing Address - Phone:817-656-9366
Mailing Address - Fax:253-838-4463
Practice Address - Street 1:4000 BROWN TRL
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3942
Practice Address - Country:US
Practice Address - Phone:817-656-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9979122300000X
TX37066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist