Provider Demographics
NPI:1740428028
Name:JOHN G. ENLOE, DDS, PLLC
Entity Type:Organization
Organization Name:JOHN G. ENLOE, DDS, PLLC
Other - Org Name:CREEKSIDE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:ENLOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-894-6064
Mailing Address - Street 1:17159 FM 2493
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762
Mailing Address - Country:US
Mailing Address - Phone:903-894-6064
Mailing Address - Fax:903-894-6057
Practice Address - Street 1:17159 FM 2493
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762
Practice Address - Country:US
Practice Address - Phone:903-894-6064
Practice Address - Fax:903-894-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14499122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty