Provider Demographics
NPI:1538416938
Name:ENSLEY, DAVID TERRY (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TERRY
Last Name:ENSLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 WORTH RD STE 4
Mailing Address - Street 2:USA DENTAL COMMAND
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6033
Mailing Address - Country:US
Mailing Address - Phone:210-221-8241
Mailing Address - Fax:
Practice Address - Street 1:2748 WORTH RD STE 4
Practice Address - Street 2:USA DENTAL COMMAND
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-6033
Practice Address - Country:US
Practice Address - Phone:210-221-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0144591223G0001X, 122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist