Provider Demographics
NPI:1588709547
Name:ENRIQUEZ, GWENDELYN DE GUZMAN (DMD)
Entity type:Individual
Prefix:DR
First Name:GWENDELYN
Middle Name:DE GUZMAN
Last Name:ENRIQUEZ
Suffix:
Gender:F
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:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-0939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222-9153
Practice Address - Country:US
Practice Address - Phone:209-674-6181
Practice Address - Fax:209-674-6191
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice