MEDICARE: GREGORY T. ENGEL, DMD, MS, PLLC

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	1223E0200X	Endodontics	0401411234	VA

General Provider Information

NPI Number	:	1740548403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY T. ENGEL, DMD, MS, PLLC

Provider Business Mailing Address
First Line	:	343 NAPLES CT
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-8378
Country	:	US
Telephone Number	:	757-613-2630
Fax Number	:	757-389-5686

Provider Business Practice Location Address
First Line	:	1432 N GREAT NECK RD
Second Line	:	SUITE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1342
Country	:	US
Telephone Number	:	787-486-7857
Fax Number	:	757-486-4441

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	DR. GREGORY THOMAS ENGEL
Credential	:	DMD, MS
Telephone Number	:	757-613-2630

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	05/01/2012

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