Provider Demographics
NPI:1053379743
Name:ENGLE, JESSE C (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:C
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 1:6600 N PASEO DE ANGEL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3053
Mailing Address - Country:US
Mailing Address - Phone:520-245-6328
Mailing Address - Fax:520-298-4375
Practice Address - Street 1:6373 E TANQUE VERDE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3851
Practice Address - Country:US
Practice Address - Phone:520-298-0427
Practice Address - Fax:520-298-4375
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34971223G0001X
AZ68701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice