Provider Demographics
NPI:1952479925
Name:ENGEL, MARK ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
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 1:1568 CREEKSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3449
Mailing Address - Country:US
Mailing Address - Phone:916-932-4656
Mailing Address - Fax:916-678-4121
Practice Address - Street 1:1568 CREEKSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-932-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58976122300000X
AZ60551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1902610OtherUNITED CONCORDIA