Provider Demographics
NPI:1780754812
Name:ENLOE, MICHAEL L (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:ENLOE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3004 ESTATE ALTONA
Mailing Address - Street 2:MEDICAL ARTS COMPLEX #5
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-5735
Mailing Address - Country:US
Mailing Address - Phone:340-774-2395
Mailing Address - Fax:340-774-2882
Practice Address - Street 1:3004 ESTATE ALTONA
Practice Address - Street 2:MEDICAL ARTS COMPLEX #5
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-5735
Practice Address - Country:US
Practice Address - Phone:340-774-2395
Practice Address - Fax:340-774-2882
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI7461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice