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General NPI Number Information
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NPI Number | 1386027704
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Entity Type | Individual
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Provider Name | MATTHEW ENNS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 30406 HAUN RD STE 740
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City | MENIFEE
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State | CA
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Zip | 92584-6816
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Country | US
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Telephone | 951-679-4624
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Fax | 951-679-2221
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Provider Business Mailing Address
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Address Line | 30406 HAUN RD STE 740
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City | MENIFEE
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State | CA
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Zip | 92584-6816
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Country | US
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Telephone | 951-679-4624
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Fax | 951-679-2221
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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 | DN1856836
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 101260
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License Number State | CA
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