Provider Demographics
NPI:1841830999
Name:ENGSTROM FAMILY DENTAL, PLLC
Entity type:Organization
Organization Name:ENGSTROM FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-881-4069
Mailing Address - Street 1:1625 RAMBLEWOOD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6367
Mailing Address - Country:US
Mailing Address - Phone:517-332-0663
Mailing Address - Fax:517-332-2240
Practice Address - Street 1:1625 RAMBLEWOOD DR STE 2
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6367
Practice Address - Country:US
Practice Address - Phone:517-332-0663
Practice Address - Fax:517-332-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003297359OtherTYPE 1 NPI
MI1750455515OtherTYPE 1 NPI