Healthcare Provider Details

I. General information

NPI: 1063895001
Provider Name (Legal Business Name): MAX M ENKIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ESSEX AVE
GLOUCESTER MA
01930-4927
US

IV. Provider business mailing address

1 ESSEX AVE
GLOUCESTER MA
01930-4927
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-9020
  • Fax: 978-283-6251
Mailing address:
  • Phone: 978-283-9020
  • Fax: 978-283-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1856952
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: