Provider Demographics
NPI:1093977928
Name:ENGRAM, TONI (DDS)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:
Last Name:ENGRAM
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 1:151 WALTON WAY
Mailing Address - Street 2:STE 102
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-8010
Mailing Address - Country:US
Mailing Address - Phone:254-582-8191
Mailing Address - Fax:254-582-9961
Practice Address - Street 1:900 CORSICANA HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2928
Practice Address - Country:US
Practice Address - Phone:254-582-8191
Practice Address - Fax:254-582-9961
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist