Provider Demographics
NPI:1821178583
Name:ENZ, MIKE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:J
Last Name:ENZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 HIGHWAY 96 W
Mailing Address - Street 2:SUITE #400
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-1962
Mailing Address - Country:US
Mailing Address - Phone:651-482-7564
Mailing Address - Fax:651-482-0349
Practice Address - Street 1:520 HIGHWAY 96 W
Practice Address - Street 2:SUITE #400
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1962
Practice Address - Country:US
Practice Address - Phone:651-482-7564
Practice Address - Fax:651-482-0349
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNAE21709741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice