Provider Demographics
NPI:1467791483
Name:BRIAN A ENESS DDS
Entity Type:Organization
Organization Name:BRIAN A ENESS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-578-8525
Mailing Address - Street 1:119 N CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-1433
Mailing Address - Country:US
Mailing Address - Phone:563-578-8525
Mailing Address - Fax:563-578-8737
Practice Address - Street 1:119 N CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1433
Practice Address - Country:US
Practice Address - Phone:563-578-8525
Practice Address - Fax:563-578-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty