Active NPI
Debra M. Enneking, DDS
- General Practice Dentistry
- Gig Harbor, WA
National Provider Identifier
1497819908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7066
- Practice address
- 6504 Wollochet Drive NW
Gig Harbor, WA 98335 - Phone
- (253) 858-5869
- Fax
- (253) 858-5849
- NPI assigned
- Dec 20, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7066 | WA | Primary |
Addresses
Primary practice location
6504 Wollochet Drive NW
Gig Harbor, WA 98335
Mailing address
6504 Wollochet Drive NW
Gig Harbor, WA 98335
Phone (253) 858-5869
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 57066 | Other | WA | WASHINGTON DENTAL SERVICE |
| 896356 | Other | UNITED CONCORDIA INS. | |
| 5017397 | Other | WA | DEPT OF SOCIAL & HEALTH |
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 |
|---|---|---|---|
| 7066 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Otgonbold DDS PLLC | General Practice | Past | Accepting new patients |
| Debra M. Enneking DDS, Inc. | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Gig Harbor, WA
- NPI 1164843694
-
- General Practice Dentistry
- Gig Harbor, WA
- NPI 1013830264
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376352000000",
"number": "1497819908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6504 WOLLOCHET DRIVE NW",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "98335",
"telephone_number": "253-858-5869",
"fax_number": "253-858-5849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6504 WOLLOCHET DRIVE NW",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "98335",
"telephone_number": "253-858-5869",
"fax_number": "253-858-5849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNEKING",
"first_name": "DEBRA",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2013-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "7066",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON DENTAL SERVICE",
"identifier": "57066",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA INS.",
"identifier": "896356",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF SOCIAL & HEALTH",
"identifier": "5017397",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gig Harbor, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.