Healthcare Provider Details

I. General information

NPI: 1750503546
Provider Name (Legal Business Name): ENIKO ALICEA D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ENIKO ALICEA D.M.D

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28255 N. TATUM BLVD SUITE #4
CAVE CREEK AZ
85331
US

IV. Provider business mailing address

28255 N. TATUM BLVD SUITE #4
CAVE CREEK AZ
85331
US

V. Phone/Fax

Practice location:
  • Phone: 480-563-4141
  • Fax:
Mailing address:
  • Phone: 480-563-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7775
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-022322
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7775
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: