Provider Demographics
NPI:1467584045
Name:ENGELHARD, GWEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GWEN
Middle Name:M
Last Name:ENGELHARD
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 1:55 E END AVE
Mailing Address - Street 2:APT. 14C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7928
Mailing Address - Country:US
Mailing Address - Phone:212-243-2023
Mailing Address - Fax:212-243-2687
Practice Address - Street 1:212 W 15TH ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6577
Practice Address - Country:US
Practice Address - Phone:212-243-2023
Practice Address - Fax:212-243-2687
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY375871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice