Provider Demographics
NPI:1538397682
Name:ENESS, BRIAN A (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:ENESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-1433
Mailing Address - Country:US
Mailing Address - Phone:563-578-8525
Mailing Address - Fax:563-578-8737
Practice Address - Street 1:119 N CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1433
Practice Address - Country:US
Practice Address - Phone:563-578-8525
Practice Address - Fax:563-578-8737
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-28
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice