Terry Egan DDS LLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

014516 Issued in MO

Legal business name

TERRY EGAN DDS LLC

Practice address

12758 Boenker LN
Bridgeton, MO 63044-2436

Phone

(314) 739-3300

NPI assigned

May 16, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Terry R Egan, DDSNPI 1649395393

Title

Manager

Phone

(314) 739-3300

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Terry R Egan, DDS

  • Periodontics
  • Bridgeton, MO
  • NPI 1649395393
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558578187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15728 TRAPP RIDGE CT",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630178742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12758 BOENKER LN",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442436",
            "telephone_number": "314-739-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TERRY EGAN DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EGAN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "314-739-3300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MO",
            "license": "014516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gemma L Tedeschi, OTR/L
• Lisa K. Tenhouse, MSW
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• Sally Terranova, LMSW
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• David A Theodoro, M.D.
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• Thomas Gotsis DDS PC

• Periodontics in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Periodontics in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.