Provider Demographics
NPI:1114076734
Name:ENSMINGER, ALETHA
Entity Type:Individual
Prefix:
First Name:ALETHA
Middle Name:
Last Name:ENSMINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 WATT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5027
Mailing Address - Country:US
Mailing Address - Phone:916-481-5057
Mailing Address - Fax:
Practice Address - Street 1:591 WATT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5027
Practice Address - Country:US
Practice Address - Phone:916-481-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice