Provider Demographics
NPI:1639224199
Name:ENGELMANN, DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:ENGELMANN
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 1:209 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-1458
Mailing Address - Country:US
Mailing Address - Phone:618-254-0185
Mailing Address - Fax:
Practice Address - Street 1:209 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-1458
Practice Address - Country:US
Practice Address - Phone:618-254-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101038Medicaid