Provider Demographics
NPI:1225496151
Name:ENG, GENE (DMD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:
Last Name:ENG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15801 CHAGALL TER
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3461
Mailing Address - Country:US
Mailing Address - Phone:484-318-6504
Mailing Address - Fax:
Practice Address - Street 1:2848 CHURCH AVE STE 201B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-8270
Practice Address - Country:US
Practice Address - Phone:484-318-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-06
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0592311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics