Provider Demographics
NPI:1891302527
Name:ENLOE, AMANDA CAITLYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CAITLYN
Last Name:ENLOE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 WINDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-7418
Mailing Address - Country:US
Mailing Address - Phone:205-516-1431
Mailing Address - Fax:
Practice Address - Street 1:2300 N HILLS ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2633
Practice Address - Country:US
Practice Address - Phone:601-474-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4230-21122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist