Provider Demographics
NPI:1245419027
Name:ENZOR, GLORIANNA ALICIA (DDS)
Entity type:Individual
Prefix:DR
First Name:GLORIANNA
Middle Name:ALICIA
Last Name:ENZOR
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 1:3220 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5102
Mailing Address - Country:US
Mailing Address - Phone:941-365-3222
Mailing Address - Fax:941-365-3226
Practice Address - Street 1:3220 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5102
Practice Address - Country:US
Practice Address - Phone:941-365-3222
Practice Address - Fax:941-365-3226
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist