Provider Demographics
NPI:1609815489
Name:ENGROFF, RICHARD LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEWIS
Last Name:ENGROFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SHIN POND RD
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-3130
Mailing Address - Country:US
Mailing Address - Phone:207-528-2749
Mailing Address - Fax:
Practice Address - Street 1:735 SHIN POND RD
Practice Address - Street 2:
Practice Address - City:PATTEN
Practice Address - State:ME
Practice Address - Zip Code:04765-3130
Practice Address - Country:US
Practice Address - Phone:207-528-2255
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME30581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice