Provider Demographics
NPI:1366474314
Name:ENGROFF, STEPHEN L (MD DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:ENGROFF
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W BEAVER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4820
Mailing Address - Country:US
Mailing Address - Phone:814-238-0587
Mailing Address - Fax:814-238-3840
Practice Address - Street 1:200 W BEAVER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-238-0587
Practice Address - Fax:814-238-3840
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0356551223P0106X, 1223S0112X
PAMD4228771223P0106X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
79677OtherGEISINGER HEALTH PLAN
EN1480132OtherHIGHMARK
EN1480132OtherHIGHMARK
PA071221FMKMedicare ID - Type Unspecified
79677OtherGEISINGER HEALTH PLAN