Gary A. Eggert, D.D.S.
Individual provider Active NPI Dentist · Berlin, WI
NPI 1619083698 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619083698
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 500-2079 (WI)
- Practice address
- 169 Memorial Dr
Berlin, WI 54923-1241 - Phone
- (920) 361-4008
- Fax
- (920) 361-6111
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 500-2079 | WI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 500-2079 | WI | Yes |
Addresses
Primary practice location
169 Memorial Dr
Berlin, WI 54923-1241
Mailing address
169 Memorial Dr
Berlin, WI 54923-1241
Phone (920) 361-4008
Other providers in Berlin, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.