Provider Demographics
NPI:1487694162
Name:EGNER, PAMELA SUSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUSAN
Last Name:EGNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E. JEFFERSON
Mailing Address - Street 2:P.O. BOX 729
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495
Mailing Address - Country:US
Mailing Address - Phone:903-482-6339
Mailing Address - Fax:903-482-1313
Practice Address - Street 1:202 E. JEFFERSON
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495
Practice Address - Country:US
Practice Address - Phone:903-482-6339
Practice Address - Fax:903-482-1313
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice