Healthcare Provider Details

I. General information

NPI: 1285250860
Provider Name (Legal Business Name): ENKIN FAMILY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ESSEX AVE
GLOUCESTER MA
01930-4927
US

IV. Provider business mailing address

21 BALDWIN ST
PEABODY MA
01960-1420
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-9020
  • Fax:
Mailing address:
  • Phone: 978-979-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAX ENKIN
Title or Position: OWNER
Credential: DMD
Phone: 978-979-4929