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NPI Code Detail

MEDICARE: DR. BETSY H ENRIQUEZ D.D.S.

MEDICARE: DR. BETSY H ENRIQUEZ D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry19A-14737IL

General Provider Information

NPI Number : 1396910808
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BETSY H ENRIQUEZ D.D.S.
Provider Business Mailing Address
First Line : 736 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4484
Country : US
Telephone Number : 773-247-3800
Fax Number :
Provider Business Practice Location Address
First Line : 736 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4484
Country : US
Telephone Number : 773-247-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2008
Last Update Date : 04/25/2008

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