MEDICARE: DR. DAVID TERRY ENSLEY DMD

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	DN014459	GA
2	122300000X	Dentist	DN014459	GA
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN014459	GA

General Provider Information

NPI Number	:	1538416938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID TERRY ENSLEY DMD

Provider Business Mailing Address
First Line	:	2748 WORTH RD STE 4
Second Line	:	USA DENTAL COMMAND
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-6033
Country	:	US
Telephone Number	:	210-221-8241
Fax Number	:

Provider Business Practice Location Address
First Line	:	2748 WORTH RD STE 4
Second Line	:	USA DENTAL COMMAND
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-6033
Country	:	US
Telephone Number	:	210-221-8241
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	06/03/2016

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