Provider Demographics
NPI:1427801570
Name:ENNEKING, ETHAN MITCHELL (DDS)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:MITCHELL
Last Name:ENNEKING
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 1:8305 FORSYTHIA DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-6772
Mailing Address - Country:US
Mailing Address - Phone:214-773-7031
Mailing Address - Fax:
Practice Address - Street 1:117 BURNETT CT
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3100
Practice Address - Country:US
Practice Address - Phone:254-848-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist