Provider Demographics
NPI:1417008046
Name:ENGLE, MARC DARREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:DARREN
Last Name:ENGLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 W GENESEE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2352
Mailing Address - Country:US
Mailing Address - Phone:315-476-5156
Mailing Address - Fax:315-475-3805
Practice Address - Street 1:5109 W GENESEE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2352
Practice Address - Country:US
Practice Address - Phone:315-476-5156
Practice Address - Fax:315-475-3805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0439571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics