Basic Information
| Provider Information | |||||||||
| NPI: | 1275753824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENGMAN | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33520 NORTH 69TH PLACE | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804883575 | ||||||||
| FaxNumber: | 4804889131 | ||||||||
| Practice Location | |||||||||
| Address1: | 4520 N CENTRAL AVE | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022795262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 6653 | AZ | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | 1223X0400X | 2830 | CO | N | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.