Provider Demographics
NPI:1427551829
Name:TODD R DENSON, DMD
Entity Type:Organization
Organization Name:TODD R DENSON, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-269-5701
Mailing Address - Street 1:2191 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2577
Mailing Address - Country:US
Mailing Address - Phone:321-269-5701
Mailing Address - Fax:321-268-0691
Practice Address - Street 1:2191 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2577
Practice Address - Country:US
Practice Address - Phone:321-269-5701
Practice Address - Fax:321-268-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13298261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTID