Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | IL |
NPI | 1033288253 |
---|---|
Provider Name | Paul Egger |
First Address | Northbrook, IL 60062-5316 |
Second Address | Northbrook, IL 60062-5316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |