| Organization Name: | PETRA V. ENZIEN, DMD, PLLC |
| NPI Number: | 1538498654 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PETRA VICTORIA ENZIEN (OWNER) |
| Mailing Address: | 211 Park Ave Mechanicville |
| State: | NY US |
| Postal Code: | 121181502 |
| Phone Number: | 5186642500 |
| Fax Number: | 5186642501 |
| NPI Enumeration Date: | 12/19/2009 |
| NPI Last Update Date: | 12/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 046460 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |