Eric Ennuson, DDS
Individual provider Active NPI General Practice Dentistry · Atlanta, GA
NPI 1104554955 · NPPES record last updated Aug 10, 2022
Key facts
- NPI
- 1104554955
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN122834 (GA)
- Practice address
- 1010 W Peachtree St NW Ste C2
Atlanta, GA 30309-4859 - Phone
- (404) 903-2006
- NPI assigned
- Aug 10, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN122834 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Floss Dental - Georgia Partners LLC | General Practice | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN122834 | GA | Yes |
Addresses
Primary practice location
1010 W Peachtree St NW Ste C2
Atlanta, GA 30309-4859
Mailing address
1010 W Peachtree St NW Ste C2
Atlanta, GA 30309-4859
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All providers in Atlanta, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.