Healthcare Provider Details

I. General information

NPI: 1700894128
Provider Name (Legal Business Name): NORMAN DENNIS ENSMINGER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 12TH ST
ALTURAS CA
96101-3306
US

IV. Provider business mailing address

PO BOX 66
ALTURAS CA
96101-0066
US

V. Phone/Fax

Practice location:
  • Phone: 530-233-3543
  • Fax: 530-233-6752
Mailing address:
  • Phone: 530-233-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: