Provider Demographics
NPI:1619302692
Name:ENGDAHL, KARL ERIK (DDS PRACTICE LIMITE)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:ERIK
Last Name:ENGDAHL
Suffix:
Gender:M
Credentials:DDS PRACTICE LIMITE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2638
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595
Mailing Address - Country:US
Mailing Address - Phone:925-939-5852
Mailing Address - Fax:925-939-9668
Practice Address - Street 1:2225 OLYMPIC BOVLEVARD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595
Practice Address - Country:US
Practice Address - Phone:925-939-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics