Provider Demographics
NPI:1104246537
Name:ENRIQUEZ, DANTE
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 MOTLEY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3460
Mailing Address - Country:US
Mailing Address - Phone:972-613-5793
Mailing Address - Fax:972-613-7236
Practice Address - Street 1:2944 MOTLEY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3460
Practice Address - Country:US
Practice Address - Phone:972-613-5793
Practice Address - Fax:972-613-7236
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1014980246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1014980Medicare PIN