Provider Demographics
NPI:1649708280
Name:ENGLE, GEORGE TYLER (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:TYLER
Last Name:ENGLE
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 1:2842 HANNA PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1496
Mailing Address - Country:US
Mailing Address - Phone:859-537-3081
Mailing Address - Fax:
Practice Address - Street 1:2911 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3036
Practice Address - Country:US
Practice Address - Phone:606-687-5853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY99321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice