Provider Demographics
NPI:1740299718
Name:ENRIQUEZ, VERONICA MARITZA (DDS)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:MARITZA
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 1:14102 SULLYFIELD CIR
Mailing Address - Street 2:#500
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1610
Mailing Address - Country:US
Mailing Address - Phone:703-378-4004
Mailing Address - Fax:703-378-6921
Practice Address - Street 1:14102 SULLYFIELD CIR
Practice Address - Street 2:#500
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1610
Practice Address - Country:US
Practice Address - Phone:703-378-4004
Practice Address - Fax:703-378-6921
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010089411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0013923Medicaid