Healthcare Provider Details

I. General information

NPI: 1609815489
Provider Name (Legal Business Name): RICHARD LEWIS ENGROFF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 SHIN POND RD
PATTEN ME
04765-3130
US

IV. Provider business mailing address

741 SHIN POND RD
PATTEN ME
04765-3130
US

V. Phone/Fax

Practice location:
  • Phone: 207-528-2255
  • Fax:
Mailing address:
  • Phone: 207-528-2749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3058
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: