MEDICARE: COLIN EGGLESTON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	41676	TX

General Provider Information

NPI Number	:	1013809722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLIN EGGLESTON DDS

Provider Business Mailing Address
First Line	:	4426 SHAVANO WOODS ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1839
Country	:	US
Telephone Number	:	210-410-2346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1862 SH-46 W
Second Line	:	STE 101
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132
Country	:	US
Telephone Number	:	830-308-5567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	07/17/2025

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