Provider Demographics
NPI:1255409041
Name:ENACOPOL, HORATIO DAN (DDS)
Entity type:Individual
Prefix:
First Name:HORATIO
Middle Name:DAN
Last Name:ENACOPOL
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 1:15900 127TH ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-2910
Mailing Address - Country:US
Mailing Address - Phone:630-243-7645
Mailing Address - Fax:630-243-6336
Practice Address - Street 1:15900 127TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-2910
Practice Address - Country:US
Practice Address - Phone:630-243-7645
Practice Address - Fax:630-243-6336
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice