MEDICARE: ENGILMAN ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	8621	KY

General Provider Information

NPI Number	:	1548413271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENGILMAN ORTHODONTICS

Provider Business Mailing Address
First Line	:	2005 S HIGHWAY 53
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-9109
Country	:	US
Telephone Number	:	502-225-0074
Fax Number	:

Provider Business Practice Location Address
First Line	:	6408 W HIGHWAY 146
Second Line	:	UNIT 10
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-9575
Country	:	US
Telephone Number	:	502-241-3176
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	STEPHEN JAMES
Credential	:
Telephone Number	:	502-254-8504

Provider Enumeration Date	:	10/26/2008
Last Update Date	:	10/26/2008

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Directions to “ENGILMAN ORTHODONTICS ” Practice Location

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