Provider Demographics
NPI:1639292238
Name:ENGELBY, JON B (DMD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:B
Last Name:ENGELBY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-4327
Mailing Address - Country:US
Mailing Address - Phone:360-856-6358
Mailing Address - Fax:360-856-6358
Practice Address - Street 1:2001 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-4327
Practice Address - Country:US
Practice Address - Phone:360-856-6358
Practice Address - Fax:360-856-6358
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000100771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice