Provider Demographics
NPI:1811352073
Name:DELCLOS, ENRIQUE
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:DELCLOS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:
Other - Last Name:DELCLOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2225 WILLIAMS TRACE BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4513
Mailing Address - Country:US
Mailing Address - Phone:281-265-4177
Mailing Address - Fax:281-265-3349
Practice Address - Street 1:2225 WILLIAMS TRACE BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4513
Practice Address - Country:US
Practice Address - Phone:281-265-4177
Practice Address - Fax:281-265-3349
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry