Healthcare Provider Details

I. General information

NPI: 1740378652
Provider Name (Legal Business Name): JOHN D ENGEL MD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 W CENTER RD
OMAHA NE
68124
US

IV. Provider business mailing address

13273 BINNEY ST
OMAHA NE
68164
US

V. Phone/Fax

Practice location:
  • Phone: 402-393-4433
  • Fax: 402-397-1687
Mailing address:
  • Phone: 402-964-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5488
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number19516
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: