Provider Demographics
NPI:1184650319
Name:DENNIS, STEPHEN D (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:DENNIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-9450
Mailing Address - Country:US
Mailing Address - Phone:417-669-7535
Mailing Address - Fax:
Practice Address - Street 1:207 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-9450
Practice Address - Country:US
Practice Address - Phone:417-669-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD024957207P00000X
MO2006016940207P00000X
CO44228207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORF66890Medicare UPIN