Individual
JOHN R ENSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2133 PEPPERRELL ST BLDG 3352, JBSA LACKLAND, TX 78236-5313
(210) 292-9054
Mailing address
201 INDEPENDENCE DR, COLUMBUS AFB, MS 39710
(662) 434-2258
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN014957
GA
Other
Enumeration date
06/17/2015
Last updated
05/11/2018
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