Provider Demographics
NPI:1326383175
Name:JAMES D. ENLOE, DDS, PC
Entity Type:Organization
Organization Name:JAMES D. ENLOE, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:ENLOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-684-0215
Mailing Address - Street 1:415 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-3027
Mailing Address - Country:US
Mailing Address - Phone:641-684-0215
Mailing Address - Fax:641-684-5072
Practice Address - Street 1:415 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3027
Practice Address - Country:US
Practice Address - Phone:641-684-0215
Practice Address - Fax:641-684-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1443770Medicaid