Provider Demographics
NPI:1952069148
Name:MORENO HERNANDEZ, ENELYS CARIDAD (DDS)
Entity Type:Individual
Prefix:
First Name:ENELYS
Middle Name:CARIDAD
Last Name:MORENO HERNANDEZ
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 1:6753 ALBATROSS LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-3603
Mailing Address - Country:US
Mailing Address - Phone:786-362-1607
Mailing Address - Fax:
Practice Address - Street 1:7731 KINGSTON PIKE STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5506
Practice Address - Country:US
Practice Address - Phone:865-525-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-04
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11796122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist