Provider Demographics
NPI:1396753265
Name:ROY D EAGLIN DMD
Entity type:Organization
Organization Name:ROY D EAGLIN DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTION
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUBATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-273-2388
Mailing Address - Street 1:411 CLIFTY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250
Mailing Address - Country:US
Mailing Address - Phone:812-273-2388
Mailing Address - Fax:812-273-5728
Practice Address - Street 1:411 CLIFTY DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250
Practice Address - Country:US
Practice Address - Phone:812-273-2388
Practice Address - Fax:812-273-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:2006-11-30
Deactivation Code:
Reactivation Date:2007-06-13
Provider Licenses
StateLicense IDTaxonomies
IN120083371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty