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General NPI Number Information
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NPI Number | 1023367083
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Entity Type | Individual
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Provider Name | CARLOS STEWART ENRIQUEZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 3801 150TH AVE SE
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City | BELLEVUE
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State | WA
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Zip | 98006-1668
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Country | US
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Telephone | 425-998-5980
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Fax | 425-998-5975
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Provider Business Mailing Address
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Address Line | 1144 SONOMA AVE STE 107
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City | SANTA ROSA
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State | CA
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Zip | 95405-4812
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Country | US
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Telephone | 707-695-5540
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Fax | 707-549-5533
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | CA-32676
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE60600830
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60600830
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License Number State | WA
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