Provider Demographics
NPI:1710158746
Name:PATTAN DDS ENGELMANN DDS LTD
Entity Type:Organization
Organization Name:PATTAN DDS ENGELMANN DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ENGELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:618-254-0185
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101038Medicaid