Individual
MARK E ENGELSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8914
(503) 494-0294
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8914
(503) 494-0294
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DF0023
OR
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD153490
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
357147500
—
MN
Enumeration date
05/18/2006
Last updated
10/10/2017
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