Active NPI
Terry Lee Eggleston, DDS
- Prosthodontics
- Santa Rosa, CA
National Provider Identifier
1770721037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 30067
- Practice address
- 55 Mission Cir
Suite 104
Santa Rosa, CA 95409-5398 - Phone
- (707) 538-7600
- Fax
- (707) 538-7696
- NPI assigned
- Jan 25, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 30067 | CA | Primary |
Addresses
Primary practice location
55 Mission Cir
Suite 104
Santa Rosa, CA 95409-5398
Mailing address
55 Mission Cir
Suite 104
Santa Rosa, CA 95409-5398
Phone (707) 538-7600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30067 | CA | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232841600000",
"number": "1770721037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 MISSION CIR",
"address_2": "SUITE 104",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954095398",
"telephone_number": "707-538-7600",
"fax_number": "707-538-7696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 MISSION CIR",
"address_2": "SUITE 104",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954095398",
"telephone_number": "707-538-7600",
"fax_number": "707-538-7696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EGGLESTON",
"first_name": "TERRY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-25",
"last_updated": "2009-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CA",
"license": "30067",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.