Provider Demographics
NPI:1003020215
Name:ENGLE, ROSEMARY ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:ELAINE
Last Name:ENGLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 SE KAMILCHE SHORES RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7742
Mailing Address - Country:US
Mailing Address - Phone:360-426-9003
Mailing Address - Fax:360-426-9013
Practice Address - Street 1:4818B SHE NAH NUM DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-9105
Practice Address - Country:US
Practice Address - Phone:360-459-5312
Practice Address - Fax:360-407-0860
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000094571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice