Provider Demographics
NPI:1841898855
Name:ENTZE, EVAN E (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:E
Last Name:ENTZE
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 1:669 12TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3554
Mailing Address - Country:US
Mailing Address - Phone:701-483-4746
Mailing Address - Fax:701-483-2273
Practice Address - Street 1:669 12TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3554
Practice Address - Country:US
Practice Address - Phone:701-483-4746
Practice Address - Fax:701-483-2273
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist