Provider Demographics
NPI:1275797870
Name:ENRIQUEZ, ANGELA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 DACY LN
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6322
Mailing Address - Country:US
Mailing Address - Phone:512-268-8950
Mailing Address - Fax:512-268-2253
Practice Address - Street 1:3066 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220-1013
Practice Address - Country:US
Practice Address - Phone:210-233-7096
Practice Address - Fax:210-277-6387
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23953OtherTEXAS BOARD OF DENTAL EXAMINERS LICENSE