Healthcare Provider Details

I. General information

NPI: 1619155397
Provider Name (Legal Business Name): ENGILMAN ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 STATE ST
NEW ALBANY IN
47150-4962
US

IV. Provider business mailing address

4801 OUTER LOOP STE A204
LOUISVILLE KY
40219-3201
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-8200
  • Fax: 812-945-3260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE JAMES
Title or Position: COO
Credential:
Phone: 502-254-8504