Provider Demographics
NPI:1508893470
Name:ENGL, ROBERT A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:ENGL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 DELAWARE AVE
Mailing Address - Street 2:P.O. BOX 24
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-0024
Mailing Address - Country:US
Mailing Address - Phone:716-874-9018
Mailing Address - Fax:716-874-0272
Practice Address - Street 1:3024 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2305
Practice Address - Country:US
Practice Address - Phone:716-874-9018
Practice Address - Fax:716-874-0272
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0377321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01010737Medicaid
NYU08435Medicare UPIN
NY01010737Medicaid