Provider Demographics
NPI:1083806004
Name:ENCE, NATHAN LEE
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:LEE
Last Name:ENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DIAGONAL ST
Mailing Address - Street 2:#102
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-628-6026
Mailing Address - Fax:435-656-4595
Practice Address - Street 1:10 DIAGONAL ST
Practice Address - Street 2:#102
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-628-6026
Practice Address - Fax:435-656-4595
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT477187199221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice