Provider Demographics
NPI:1619144797
Name:ENGELMAN&FROUG PA
Entity Type:Organization
Organization Name:ENGELMAN&FROUG PA
Other - Org Name:SEMINOLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-398-0085
Mailing Address - Street 1:11179 PARK BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4709
Mailing Address - Country:US
Mailing Address - Phone:727-398-0085
Mailing Address - Fax:727-397-1420
Practice Address - Street 1:11179 PARK BLVD STE 13
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4709
Practice Address - Country:US
Practice Address - Phone:727-398-0085
Practice Address - Fax:727-397-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD104821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19OtherSINGLE SPECIALTY