Provider Demographics
NPI:1518147206
Name:DR. LARRY ENGMAN ADULT ORTHODONTICS
Entity Type:Organization
Organization Name:DR. LARRY ENGMAN ADULT ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ENGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-585-4244
Mailing Address - Street 1:10401 E MCDOWELL MOUNTAIN RANCH RD
Mailing Address - Street 2:STE. 4
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8698
Mailing Address - Country:US
Mailing Address - Phone:480-585-4244
Mailing Address - Fax:480-513-4166
Practice Address - Street 1:10401 E MCDOWELL MOUNTAIN RANCH RD
Practice Address - Street 2:STE. 4
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8698
Practice Address - Country:US
Practice Address - Phone:480-585-4244
Practice Address - Fax:480-513-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD66531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty