Healthcare Provider Details

I. General information

NPI: 1013837632
Provider Name (Legal Business Name): BENJAMIN JEROME ENGLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 ADMIRAL TAUSSIG BLVD
NORFOLK VA
23511-2803
US

IV. Provider business mailing address

148 WESTOVER AVE
NORFOLK VA
23507-2302
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-8591
  • Fax:
Mailing address:
  • Phone: 712-635-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420120
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: