Provider Demographics
NPI:1285250860
Name:ENKIN FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:ENKIN FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:ENKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-979-4929
Mailing Address - Street 1:21 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1420
Mailing Address - Country:US
Mailing Address - Phone:978-979-4929
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental