Basic Information
| Provider Information | |||||||||
| NPI: | 1275797870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENRIQUEZ | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2810 DACY LN | ||||||||
| Address2: | |||||||||
| City: | KYLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786406322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122688950 | ||||||||
| FaxNumber: | 5122682253 | ||||||||
| Practice Location | |||||||||
| Address1: | 3066 E COMMERCE ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782201013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102337096 | ||||||||
| FaxNumber: | 2102776387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2008 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 23953 | TX | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 23953 | 01 | TX | TEXAS BOARD OF DENTAL EXAMINERS LICENSE | OTHER |