Provider Demographics
NPI:1194890020
Name:ENGLE, ANTHONY D (DMD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:ENGLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 MOODY PKWY
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3012
Mailing Address - Country:US
Mailing Address - Phone:205-640-1717
Mailing Address - Fax:205-640-4902
Practice Address - Street 1:2323 MOODY PKWY
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3012
Practice Address - Country:US
Practice Address - Phone:205-640-1717
Practice Address - Fax:205-640-4902
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51503516ENGOtherBLUE CROSS AND BLUE SHIEL