Provider Demographics
NPI:1750453395
Name:ENGELMAN, GREG (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:ENGELMAN
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 1:6030 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3228
Mailing Address - Country:US
Mailing Address - Phone:727-547-6453
Mailing Address - Fax:727-548-7957
Practice Address - Street 1:6030 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3228
Practice Address - Country:US
Practice Address - Phone:727-547-6453
Practice Address - Fax:727-548-7957
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL104821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice