Provider Demographics
NPI:1184730293
Name:ENGSTROM, JANICE LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:LYNN
Last Name:ENGSTROM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3852
Mailing Address - Country:US
Mailing Address - Phone:765-284-7242
Mailing Address - Fax:
Practice Address - Street 1:202 N RESERVE ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3852
Practice Address - Country:US
Practice Address - Phone:765-284-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist