Provider Demographics
NPI:1497819908
Name:ENNEKING, DEBRA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:M
Last Name:ENNEKING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 WOLLOCHET DRIVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-858-5869
Mailing Address - Fax:253-858-5849
Practice Address - Street 1:6504 WOLLOCHET DRIVE NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-858-5869
Practice Address - Fax:253-858-5849
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA70661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA57066OtherWASHINGTON DENTAL SERVICE
896356OtherUNITED CONCORDIA INS.
WA5017397OtherDEPT OF SOCIAL & HEALTH