Provider Demographics
NPI:1033264676
Name:AMY, ENRIQUE (DMD,MDS)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:AMY
Suffix:
Gender:M
Credentials:DMD,MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8129 CALLE CONCORDIA
Mailing Address - Street 2:SUITE 502
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1548
Mailing Address - Country:US
Mailing Address - Phone:787-844-0125
Mailing Address - Fax:
Practice Address - Street 1:8129 CALLE CONCORDIA
Practice Address - Street 2:SUITE 502
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1548
Practice Address - Country:US
Practice Address - Phone:787-848-1002
Practice Address - Fax:787-844-9019
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics