Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901021549 | MI |
NPI | 1003297359 |
---|---|
Provider Name | Dr. Dennis Albert Engstrom |
First Address | East Lansing, MI 48823-7785 |
Second Address | East Lansing, MI 48823-7785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2015 |
Last Update Date | 12/06/2015 |