Healthcare Provider Details

I. General information

NPI: 1306838230
Provider Name (Legal Business Name): ELIZABETH EGGERT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 VILLAGE CENTER DR SUITE 160
NORTH OAKS MN
55127-3019
US

IV. Provider business mailing address

1301 7TH ST SW
NEW BRIGHTON MN
55112-7653
US

V. Phone/Fax

Practice location:
  • Phone: 651-482-8412
  • Fax: 651-482-8376
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11799
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: