Basic Information
| Provider Information | |||||||||
| NPI: | 1083806004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENCE | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 DIAGONAL ST | ||||||||
| Address2: | #102 | ||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356286026 | ||||||||
| FaxNumber: | 4356564595 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 DIAGONAL ST | ||||||||
| Address2: | #102 | ||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356286026 | ||||||||
| FaxNumber: | 4356564595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 08/14/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 47718719922 | UT | Y | Dental Providers | Dentist | General Practice |
No ID Information.