Provider Demographics
NPI:1174929566
Name:MIKE ENICH DENTAL PLLC
Entity type:Organization
Organization Name:MIKE ENICH DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ENICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-263-8348
Mailing Address - Street 1:2005 8TH AVE E
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1707
Mailing Address - Country:US
Mailing Address - Phone:218-263-8348
Mailing Address - Fax:
Practice Address - Street 1:2005 8TH AVE E
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1707
Practice Address - Country:US
Practice Address - Phone:218-263-8348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty