Healthcare Provider Details

I. General information

NPI: 1447791454
Provider Name (Legal Business Name): ENRIQUE MARTIN SCHUBERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 07/23/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

500 NW 36TH ST APT 510
MIAMI FL
33127-3146
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5326
  • Fax: 305-256-5208
Mailing address:
  • Phone: 305-799-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code125K00000X
TaxonomyAdvanced Practice Dental Therapist
License Number00000
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number38087
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: