Provider Demographics
NPI:1518159672
Name:ENLOW-MOIR, REGAN (RDH)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:ENLOW-MOIR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4306
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-4306
Mailing Address - Country:US
Mailing Address - Phone:907-486-2687
Mailing Address - Fax:
Practice Address - Street 1:BUILDING N46
Practice Address - Street 2:CAPE SARICHEF STREET
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99619
Practice Address - Country:US
Practice Address - Phone:907-486-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK690124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist