MEDICARE: DR. GREGORY THOMAS ENGEL DMD, MS

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	1223E0200X	Endodontics	0401411234	VA
2	1223E0200X	Endodontics	DS030278L	PA

General Provider Information

NPI Number	:	1962482323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY THOMAS ENGEL DMD, MS

Provider Business Mailing Address
First Line	:	343 NAPLES CT
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-8378
Country	:	US
Telephone Number	:	757-389-5686
Fax Number	:	757-389-5686

Provider Business Practice Location Address
First Line	:	1432 N GREAT NECK RD
Second Line	:	SUITE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1342
Country	:	US
Telephone Number	:	757-486-7857
Fax Number	:	757-486-7857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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