MEDICARE: DEBRA M. ENNEKING, D.D.S.,P.L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7066	WA

General Provider Information

NPI Number	:	1295941235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA M. ENNEKING, D.D.S.,P.L.L.C.

Provider Business Mailing Address
First Line	:	2425 33RD AVE W STE A1
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3255
Country	:	US
Telephone Number	:	206-283-7844
Fax Number	:	206-283-9233

Provider Business Practice Location Address
First Line	:	2425 33RD AVE W STE A1
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3255
Country	:	US
Telephone Number	:	206-283-7844
Fax Number	:	206-283-9233

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. DEBRA M ENNEKING
Credential	:	D.D.S.
Telephone Number	:	206-283-7844

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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