| Organization Name: | BRYCE R EAGAR DDS PLLC |
| NPI Number: | 1225431307 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRYCE EAGAR (MANAGER DENTIST) |
| Mailing Address: | 720 S. River Rd. Ste B-210 St. George |
| State: | UT US |
| Postal Code: | 84790 |
| Phone Number: | 4356560507 |
| Fax Number: | 4356563791 |
| NPI Enumeration Date: | 10/02/2014 |
| NPI Last Update Date: | 05/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 9052028-9922 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |