Active NPI
John R Ensley, DMD
- Dentist
- Jbsa Lackland, TX
National Provider Identifier
1326429077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN014957
- Practice address
- 2133 Pepperrell St BLDG 3352
Jbsa Lackland, TX 78236-5313 - Phone
- (210) 292-9054
- NPI assigned
- Jun 17, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN014957 | GA | Primary |
Addresses
Primary practice location
2133 Pepperrell St BLDG 3352
Jbsa Lackland, TX 78236-5313
Mailing address
201 Independence Dr
Columbus Afb, MS 39710
Phone (662) 434-2258
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN014957 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525996800000",
"number": "1326429077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 INDEPENDENCE DR",
"city": "COLUMBUS AFB",
"state": "MS",
"postal_code": "39710",
"telephone_number": "662-434-2258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2133 PEPPERRELL ST BLDG 3352",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782365313",
"telephone_number": "210-292-9054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENSLEY",
"first_name": "JOHN",
"middle_name": "R",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-17",
"last_updated": "2018-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN014957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jbsa Lackland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.