Provider Demographics
NPI:1497743710
Name:DENNISON, ROBERT CRAWFORD (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CRAWFORD
Last Name:DENNISON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 LAPEER AVE
Mailing Address - Street 2:HEALTH DELIVERY INC
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607
Mailing Address - Country:US
Mailing Address - Phone:989-759-6400
Mailing Address - Fax:989-759-6423
Practice Address - Street 1:2308 WADSWORTH AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-1435
Practice Address - Country:US
Practice Address - Phone:989-792-7771
Practice Address - Fax:989-754-8792
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4234625Medicaid
381908328OtherDENTEMAX
88170MIOtherOUTER DRIVE
88171MIOtherCOMMERCE
OO434368OtherUNITED CONCORDIA
381908328OtherDENTAL HEALTH ALLIANCE
381908328OtherGOLDEN DENTAL PLANS
381908328OtherMETLIFE
88123MIOtherBAYSIDE
D801095OtherBLUE CROSS
381908328OtherGUARDIAN
381908328020OtherDENTAL BLUE
88096MIOtherWADSWORTH