MEDICARE: DR. ANNETTE ENZWEILER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30-024536	OH
2	122300000X	Dentist	9589	KY

General Provider Information

NPI Number	:	1932582798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNETTE ENZWEILER DMD

Provider Business Mailing Address
First Line	:	68 ELBLAINE DR
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076-1513
Country	:	US
Telephone Number	:	859-445-3064
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 GRANDVIEW DR
Second Line	:
City	:	FORT MITCHELL
State	:	KY
Zip	:	41017-1695
Country	:	US
Telephone Number	:	859-344-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	09/28/2016

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