Individual provider Active NPI

Carlos Stewart Enriquez, D.D.S.

  • Dentist
  • Bellevue, WA
National Provider Identifier
1023367083
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE60600830 Issued in WA
Practice address
3801 150TH Ave SE
Bellevue, WA 98006-1668
Phone
(425) 998-5980
Fax
(425) 998-5975
NPI assigned
Sep 6, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X CA-32676 CA
General Practice Dentistry 1223G0001X DE60600830 WA
Dentist 122300000X DE60600830 WA Primary

Addresses

Primary practice location

3801 150TH Ave SE
Bellevue, WA 98006-1668

Mailing address

1144 Sonoma Ave Ste 107
Santa Rosa, CA 95405-4812
Phone (707) 695-5540

Other practice location 1

1144 Sonoma Ave Ste 107
Santa Rosa, CA 95405-4812
Phone (707) 695-5540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CA-32676CAMDDentist
DE60600830WAMDDentist

Interoperability endpoints

  • Direct secure messaging: cenriquez452687@direct.multicare.org

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1023367083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1144 SONOMA AVE STE 107",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054812",
            "telephone_number": "707-695-5540",
            "fax_number": "707-549-5533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 150TH AVE SE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980061668",
            "telephone_number": "425-998-5980",
            "fax_number": "425-998-5975"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1144 Sonoma Ave Ste 107",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954054812",
            "country_code": "US",
            "telephone_number": "707-695-5540",
            "fax_number": "707-549-5533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENRIQUEZ",
        "first_name": "CARLOS",
        "middle_name": "STEWART",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-06",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "CA-32676",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60600830",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60600830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.