Basic Information
| Provider Information | |||||||||
| NPI: | 1841898855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENTZE | ||||||||
| FirstName: | EVAN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 669 12TH ST W | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586013554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014834746 | ||||||||
| FaxNumber: | 7014832273 | ||||||||
| Practice Location | |||||||||
| Address1: | 669 12TH ST W | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586013554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014834746 | ||||||||
| FaxNumber: | 7014832273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2020 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2416 | ND | Y | Dental Providers | Dentist |
No ID Information.