Provider Demographics
NPI:1578542866
Name:ENRIQUEZ, ENRIAL LANDICHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ENRIAL
Middle Name:LANDICHO
Last Name:ENRIQUEZ
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 1:11500 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3204
Mailing Address - Country:US
Mailing Address - Phone:727-827-2877
Mailing Address - Fax:
Practice Address - Street 1:11500 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3204
Practice Address - Country:US
Practice Address - Phone:727-827-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist