Provider Demographics
NPI:1598983934
Name:ENGSTROM, TODD G (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:G
Last Name:ENGSTROM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7200 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5384
Mailing Address - Country:US
Mailing Address - Phone:919-870-7200
Mailing Address - Fax:870-870-1742
Practice Address - Street 1:7200 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5384
Practice Address - Country:US
Practice Address - Phone:919-870-7200
Practice Address - Fax:870-870-1742
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC39151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics