Provider Demographics
NPI:1194843854
Name:DENNIS, BEATRIZ T (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEATRIZ
Middle Name:T
Last Name:DENNIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3126
Mailing Address - Country:US
Mailing Address - Phone:864-232-0440
Mailing Address - Fax:864-232-0441
Practice Address - Street 1:905 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3126
Practice Address - Country:US
Practice Address - Phone:864-232-0440
Practice Address - Fax:864-232-0441
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3820Medicaid