Provider Demographics
NPI:1063895001
Name:ENKIN, MAX M (DMD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:M
Last Name:ENKIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4927
Mailing Address - Country:US
Mailing Address - Phone:978-283-9020
Mailing Address - Fax:978-283-6251
Practice Address - Street 1:1 ESSEX AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4927
Practice Address - Country:US
Practice Address - Phone:978-283-9020
Practice Address - Fax:978-283-6251
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist