Healthcare Provider Details

I. General information

NPI: 1033264676
Provider Name (Legal Business Name): ENRIQUE AMY DMD,MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8129 CALLE CONCORDIA SUITE 502
PONCE PR
00717-1548
US

IV. Provider business mailing address

8129 CALLE CONCORDIA SUITE 502
PONCE PR
00717-1548
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-1002
  • Fax: 787-844-9019
Mailing address:
  • Phone: 787-844-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number769
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: