Provider Demographics
NPI:1932771425
Name:ENNS, CARLIE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLIE
Middle Name:M
Last Name:ENNS
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 1:114 RUEBUCK RD
Mailing Address - Street 2:
Mailing Address - City:CLEAR BROOK
Mailing Address - State:VA
Mailing Address - Zip Code:22624-1420
Mailing Address - Country:US
Mailing Address - Phone:540-535-9827
Mailing Address - Fax:
Practice Address - Street 1:1823 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5015
Practice Address - Country:US
Practice Address - Phone:540-535-9827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006951-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist