Healthcare Provider Details

I. General information

NPI: 1780754812
Provider Name (Legal Business Name): MICHAEL L. ENLOE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 ESTATE ALTONA MEDICAL ARTS COMPLEX #5
ST THOMAS VI
00802-5735
US

IV. Provider business mailing address

3004 ESTATE ALTONA MEDICAL ARTS COMPLEX #5
ST THOMAS VI
00802-5735
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-2395
  • Fax: 340-774-2882
Mailing address:
  • Phone: 340-774-2395
  • Fax: 340-774-2882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number746
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: