Provider Demographics
NPI:1376585018
Name:DENGLER, DENETTE J (MD)
Entity Type:Individual
Prefix:
First Name:DENETTE
Middle Name:J
Last Name:DENGLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 ALHAMBRA BLVD
Mailing Address - Street 2:410
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5243
Mailing Address - Country:US
Mailing Address - Phone:916-457-4263
Mailing Address - Fax:916-731-7809
Practice Address - Street 1:1201 ALHAMBRA BLVD
Practice Address - Street 2:#410
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5243
Practice Address - Country:US
Practice Address - Phone:916-457-4263
Practice Address - Fax:916-731-7809
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF12932Medicare UPIN
CA1376585018Medicare NSC