Provider Demographics
NPI:1144865445
Name:EGGART, LAURENCE
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:
Last Name:EGGART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13650 E COLFAX AVE APT 4503
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-7075
Mailing Address - Country:US
Mailing Address - Phone:843-446-4667
Mailing Address - Fax:
Practice Address - Street 1:10650 GARDEN DR UNIT 106
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-7019
Practice Address - Country:US
Practice Address - Phone:303-366-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist