Provider Demographics
NPI:1326380528
Name:ENG, MICHELLE AHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:AHN
Last Name:ENG
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 1:30092 IVY GLENN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5027
Mailing Address - Country:US
Mailing Address - Phone:949-249-8721
Mailing Address - Fax:
Practice Address - Street 1:30092 IVY GLENN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5027
Practice Address - Country:US
Practice Address - Phone:949-249-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice