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General NPI Number Information
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NPI Number | 1972097574
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Entity Type | Individual
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Provider Name | ENNSEN DAVID JOSHUA MURAO DDS
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Gender | Male
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 8041 S 83RD AVE
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City | LA VISTA
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State | NE
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Zip | 68128-2490
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Country | US
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Telephone | 402-884-1174
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Fax |
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Provider Business Mailing Address
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Address Line | 805 WESTERN HILLS DR
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City | PAPILLION
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State | NE
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Zip | 68046-7040
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Country | US
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Telephone | 808-636-5008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN.00203627
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 08
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License Number State | NE
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