Provider Demographics
NPI:1699925099
Name:EGGENBERGER, HEATHER CC (DDS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:CC
Last Name:EGGENBERGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 COLBY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4032
Mailing Address - Country:US
Mailing Address - Phone:360-259-4156
Mailing Address - Fax:360-259-4017
Practice Address - Street 1:3125 COLBY AVE STE D
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4032
Practice Address - Country:US
Practice Address - Phone:360-259-4156
Practice Address - Fax:360-259-4017
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60084768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist