Individual
DR. JEREMY LEWIS EGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
3100 E ZORA ST, WEBB CITY, MO 64870-9770
(417) 228-8286
Mailing address
11916 S OXFORD AVE STE 103, TULSA, OK 74137-7781
(918) 395-8305
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
7760
OK
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2024047374
MO
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
234
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2017
Last updated
01/20/2025
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