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General NPI Number Information
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NPI Number | 1043215031
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Entity Type | Individual
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Provider Name | HOWARD GLENN EAGLE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 333 H ST
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City | CHULA VISTA
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State | CA
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Zip | 91910-5555
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Country | US
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Telephone | 619-426-7582
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Fax | 619-781-9062
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Provider Business Mailing Address
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Address Line | 8896 HAMPE CT
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City | SAN DIEGO
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State | CA
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Zip | 92129-4457
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Country | US
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Telephone | 858-538-4805
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 43943
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License Number State | CA
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