Provider Demographics
NPI:1013809722
Name:EGGLESTON, COLIN (DDS)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:EGGLESTON
Suffix:
Gender:X
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 SHAVANO WOODS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1839
Mailing Address - Country:US
Mailing Address - Phone:210-410-2346
Mailing Address - Fax:
Practice Address - Street 1:1862 SH-46 W
Practice Address - Street 2:STE 101
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132
Practice Address - Country:US
Practice Address - Phone:830-308-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX416761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice