Provider Demographics
NPI:1700183035
Name:GLORI ENZOR, DDS, PA
Entity Type:Organization
Organization Name:GLORI ENZOR, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENZOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-365-3222
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14434305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization