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General NPI Number Information
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NPI Number | 1831239417
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Entity Type | Individual
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Provider Name | MARY J. EGAN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 5911 N HONORE AVE STE 222
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City | SARASOTA
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State | FL
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Zip | 34243-2657
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Country | US
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Telephone | 941-587-6828
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Fax |
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Provider Business Mailing Address
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Address Line | 5911 N HONORE AVE STE 222
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City | SARASOTA
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State | FL
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Zip | 34243-2657
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Country | US
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Telephone | 941-587-6828
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16326
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License Number State | FL
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