Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 43943 | CA |
NPI | 1043215031 |
---|---|
Provider Name | Dr. Howard Glenn Eagle |
First Address | San Diego, CA 92129-4457 |
Second Address | Chula Vista, CA 91910-5555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 26/02/2013 |