MEDICARE: DR. RICHARD LEWIS ENGROFF 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	1223G0001X	General Practice Dentistry	3058	ME

General Provider Information

NPI Number	:	1609815489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LEWIS ENGROFF DDS

Provider Business Mailing Address
First Line	:	741 SHIN POND RD
Second Line	:
City	:	PATTEN
State	:	ME
Zip	:	04765-3130
Country	:	US
Telephone Number	:	207-528-2749
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 SHIN POND RD
Second Line	:
City	:	PATTEN
State	:	ME
Zip	:	04765-3130
Country	:	US
Telephone Number	:	207-528-2255
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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