MEDICARE: DR. PAMELA SUSAN EGNER 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	20323	TX

General Provider Information

NPI Number	:	1487694162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA SUSAN EGNER DDS

Provider Business Mailing Address
First Line	:	202 E. JEFFERSON
Second Line	:	P.O. BOX 729
City	:	VAN ALSTYNE
State	:	TX
Zip	:	75495
Country	:	US
Telephone Number	:	903-482-6339
Fax Number	:	903-482-1313

Provider Business Practice Location Address
First Line	:	202 E. JEFFERSON
Second Line	:
City	:	VAN ALSTYNE
State	:	TX
Zip	:	75495
Country	:	US
Telephone Number	:	903-482-6339
Fax Number	:	903-482-1313

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	04/18/2012

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