Provider Demographics
NPI:1447472824
Name:MICHAEL L. ENGELBRECHT, PC
Entity type:Organization
Organization Name:MICHAEL L. ENGELBRECHT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-492-9420
Mailing Address - Street 1:6565 SOUTH YALE AVENUE
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136
Mailing Address - Country:US
Mailing Address - Phone:918-492-9420
Mailing Address - Fax:918-492-4768
Practice Address - Street 1:6565 SOUTH YALE AVENUE
Practice Address - Street 2:SUITE 1104
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-492-9420
Practice Address - Fax:918-492-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty