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General NPI Number Information
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NPI Number | 1174929566
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Entity Type | Organization
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Legal Business Name | MIKE ENICH DENTAL PLLC
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 2005 8TH AVE E
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City | HIBBING
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State | MN
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Zip | 55746-1707
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Country | US
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Telephone | 218-263-8348
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 8TH AVE E
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City | HIBBING
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State | MN
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Zip | 55746-1707
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Country | US
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Telephone | 218-263-8348
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MICHAEL R. ENICH JR.
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Credential | DDS
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Telephone | 218-263-8348
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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 | 10611
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License Number State | MN
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