Basic Information
| Provider Information | |||||||||
| NPI: | 1003297359 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENGSTROM | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | ALBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1451 E LANSING DR | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488237785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173328877 | ||||||||
| FaxNumber: | 5173328848 | ||||||||
| Practice Location | |||||||||
| Address1: | 1451 E LANSING DR | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488237785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173328877 | ||||||||
| FaxNumber: | 5173328848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2015 | ||||||||
| LastUpdateDate: | 06/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2901021549 | MI | Y | Dental Providers | Dentist |
No ID Information.