Provider Demographics
NPI:1295806131
Name:WEST, STEVEN ENSLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ENSLEY
Last Name:WEST
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 1:201 E SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-2621
Mailing Address - Country:US
Mailing Address - Phone:515-961-8673
Mailing Address - Fax:515-961-6824
Practice Address - Street 1:201 E SALEM AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-2621
Practice Address - Country:US
Practice Address - Phone:515-961-8673
Practice Address - Fax:515-961-6824
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06153122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA#0037309Medicaid