Provider Demographics
NPI:1902041726
Name:ENGEL, TODD BLAIR (DDS)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:BLAIR
Last Name:ENGEL
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 1:600 CORPORATE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2112
Mailing Address - Country:US
Mailing Address - Phone:949-542-7200
Mailing Address - Fax:949-542-7207
Practice Address - Street 1:600 CORPORATE DR STE 260
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2112
Practice Address - Country:US
Practice Address - Phone:949-542-7200
Practice Address - Fax:949-542-7207
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist