Healthcare Provider Details

I. General information

NPI: 1952069148
Provider Name (Legal Business Name): ENELYS PAEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 20TH ST NW
CLEVELAND TN
37311-3803
US

IV. Provider business mailing address

3024 22ND ST NW
CLEVELAND TN
37312-2391
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-7696
  • Fax:
Mailing address:
  • Phone: 786-362-1607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11796
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: