Provider Demographics
NPI:1124287453
Name:ENRIQUEZ, STEPHEN ERIC (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ERIC
Last Name:ENRIQUEZ
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 1:12 HDSN VLY PROF PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3101
Mailing Address - Country:US
Mailing Address - Phone:845-562-3370
Mailing Address - Fax:845-562-1733
Practice Address - Street 1:12 HDSN VLY PROF PLZ
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3101
Practice Address - Country:US
Practice Address - Phone:845-562-3370
Practice Address - Fax:845-562-1733
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist