Provider Demographics
NPI:1497858617
Name:ENGILMAN ORTHODONTICS
Entity Type:Organization
Organization Name:ENGILMAN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,DS
Authorized Official - Phone:502-253-2201
Mailing Address - Street 1:134 N EVERGREEN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDDLETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1487
Mailing Address - Country:US
Mailing Address - Phone:502-253-2201
Mailing Address - Fax:502-253-2202
Practice Address - Street 1:134 N EVERGREEN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDDLETOWN
Practice Address - State:KY
Practice Address - Zip Code:40243-1487
Practice Address - Country:US
Practice Address - Phone:502-253-2201
Practice Address - Fax:502-253-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental