Provider Demographics
NPI:1427387737
Name:ACKROYD, DENNIS GRANT (02281945)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:GRANT
Last Name:ACKROYD
Suffix:
Gender:M
Credentials:02281945
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2001
Mailing Address - Country:US
Mailing Address - Phone:541-212-7834
Mailing Address - Fax:541-889-4472
Practice Address - Street 1:1457 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2001
Practice Address - Country:US
Practice Address - Phone:541-212-7834
Practice Address - Fax:541-889-4472
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4171347343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)