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General NPI Number Information
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NPI Number | 1538269063
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Entity Type | Individual
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Provider Name | ENEHIZENA NEHITADA EHONDOR DMD
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 11/22/2007
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Provider Practice Location Address
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Address Line | 445 E FM 1382 SUITE 6
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City | CEDAR HILL
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State | TX
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Zip | 75104-6047
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Country | US
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Telephone | 469-272-0003
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Fax |
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Provider Business Mailing Address
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Address Line | 6061 VILLAGE BEND DR APT 901
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City | DALLAS
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State | TX
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Zip | 75206-3521
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Country | US
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Telephone | 267-975-2039
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22405
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License Number State | TX
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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 | 22405
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License Number State | TX
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