Provider Demographics
NPI:1477618411
Name:ENGELBRECHT, MICHAEL LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:ENGELBRECHT
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 1:6565 S YALE AVE
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8378
Mailing Address - Country:US
Mailing Address - Phone:918-492-9420
Mailing Address - Fax:918-492-4768
Practice Address - Street 1:6565 S YALE AVE
Practice Address - Street 2:SUITE 1104
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8378
Practice Address - Country:US
Practice Address - Phone:918-492-9420
Practice Address - Fax:918-492-4768
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice