Provider Demographics
NPI:1255491130
Name:DENNANY, RAYMOND L III (DDS)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:L
Last Name:DENNANY
Suffix:III
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 1:21 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834
Mailing Address - Country:US
Mailing Address - Phone:812-448-3639
Mailing Address - Fax:812-446-0250
Practice Address - Street 1:21 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834
Practice Address - Country:US
Practice Address - Phone:812-448-3639
Practice Address - Fax:812-446-0250
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120083071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100079230Medicaid