MEDICARE: TODD G ENGSTROM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	3915	NC

General Provider Information

NPI Number	:	1598983934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD G ENGSTROM DDS

Provider Business Mailing Address
First Line	:	7200 FALLS OF NEUSE RD
Second Line	:	SUITE 201
City	:	RALEIGH
State	:	NC
Zip	:	27615-5384
Country	:	US
Telephone Number	:	919-870-7200
Fax Number	:	870-870-1742

Provider Business Practice Location Address
First Line	:	7200 FALLS OF NEUSE RD
Second Line	:	SUITE 201
City	:	RALEIGH
State	:	NC
Zip	:	27615-5384
Country	:	US
Telephone Number	:	919-870-7200
Fax Number	:	870-870-1742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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