Provider Demographics
NPI:1013985829
Name:ENSOR, GARY HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:HOWARD
Last Name:ENSOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:DEPARTMENT OF MEDICAL EDUCATION
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-2204
Mailing Address - Fax:937-208-5393
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:DEPARTMENT OF MEDICAL EDUCATION
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-2204
Practice Address - Fax:937-208-5393
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 . 138761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice