Provider Demographics
NPI:1962482323
Name:ENGEL, GREGORY THOMAS (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:THOMAS
Last Name:ENGEL
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:343 NAPLES CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8378
Mailing Address - Country:US
Mailing Address - Phone:757-389-5686
Mailing Address - Fax:757-389-5686
Practice Address - Street 1:1432 N GREAT NECK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1342
Practice Address - Country:US
Practice Address - Phone:757-486-7857
Practice Address - Fax:757-486-7857
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014112341223E0200X
PADS030278L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics