Provider Demographics
NPI:1427060003
Name:ENEIX, BRADFORD VICTOR (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:VICTOR
Last Name:ENEIX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 MURPHY WOODS ROAD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511
Mailing Address - Country:US
Mailing Address - Phone:608-362-9391
Mailing Address - Fax:608-362-8020
Practice Address - Street 1:2359 MURPHY WOODS ROAD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-362-9391
Practice Address - Fax:608-362-8020
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21720151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33418700Medicaid
WI76108Medicare ID - Type Unspecified
T61858Medicare UPIN