Provider Demographics
NPI:1457490609
Name:DARGIS, DAVID DENNIS (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DENNIS
Last Name:DARGIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1609
Mailing Address - Country:US
Mailing Address - Phone:989-356-2400
Mailing Address - Fax:989-354-2606
Practice Address - Street 1:109 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1609
Practice Address - Country:US
Practice Address - Phone:989-356-2400
Practice Address - Fax:989-354-2606
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457490609Medicaid
MI0P53440Medicare PIN
MII25899Medicare UPIN
MIP00462458Medicare PIN