Provider Demographics
NPI:1760696694
Name:POSADA, ENRIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:POSADA
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 1:2154 LOMA LINDA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2769
Mailing Address - Country:US
Mailing Address - Phone:505-663-0697
Mailing Address - Fax:
Practice Address - Street 1:3500 TRINITY DR
Practice Address - Street 2:STE.B-3
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-1775
Practice Address - Country:US
Practice Address - Phone:505-662-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist