Provider Demographics
NPI:1447791454
Name:SCHUBERT, ENRIQUE MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:MARTIN
Last Name:SCHUBERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NW 36TH ST APT 510
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-3146
Mailing Address - Country:US
Mailing Address - Phone:305-799-7275
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-5326
Practice Address - Fax:305-256-5208
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00000125K00000X
TX38087204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No125K00000XDental ProvidersAdvanced Practice Dental Therapist