| Organization Name: | ENGILMAN ORTHODONTICS - LAGRANGE |
| NPI Number: | 1104090091 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHEN JAMES (CFO) |
| Mailing Address: | 2005 S Highway 53 Suite B La Grange |
| State: | KY US |
| Postal Code: | 400319109 |
| Phone Number: | 5022224613 |
| Fax Number: | 5022250882 |
| NPI Enumeration Date: | 04/22/2008 |
| NPI Last Update Date: | 06/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |