Provider Demographics
NPI:1376606657
Name:HIBBING DENTAL SERVICE PA
Entity Type:Organization
Organization Name:HIBBING DENTAL SERVICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ENICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-263-8348
Mailing Address - Street 1:2005 8TH AVENUE EAST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746
Mailing Address - Country:US
Mailing Address - Phone:218-263-8348
Mailing Address - Fax:218-263-5898
Practice Address - Street 1:2005 8TH AVENUE EAST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746
Practice Address - Country:US
Practice Address - Phone:218-263-8348
Practice Address - Fax:218-263-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty