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General NPI Number Information
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NPI Number | 1841830999
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Entity Type | Organization
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Legal Business Name | ENGSTROM FAMILY DENTAL, PLLC
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 1625 RAMBLEWOOD DR STE 2
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City | EAST LANSING
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State | MI
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Zip | 48823-6367
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Country | US
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Telephone | 517-332-0663
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Fax | 517-332-2240
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Provider Business Mailing Address
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Address Line | 1625 RAMBLEWOOD DR STE 2
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City | EAST LANSING
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State | MI
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Zip | 48823-6367
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Country | US
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Telephone | 517-332-0663
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Fax | 517-332-2240
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Authorized Official
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Title or Position | LLC MEMBER
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Name | DR. DENNIS A ENGSTROM
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Credential | DDS
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Telephone | 517-881-4069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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