Provider Demographics
NPI:1518974732
Name:DINGLE, DENISE R (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:DINGLE
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 1:516 W MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-1142
Mailing Address - Country:US
Mailing Address - Phone:615-597-4049
Mailing Address - Fax:615-597-7300
Practice Address - Street 1:516 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-1142
Practice Address - Country:US
Practice Address - Phone:615-597-4049
Practice Address - Fax:615-597-7300
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD022016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0130799OtherBCBST
TN3064940Medicaid
TN3064940Medicare ID - Type Unspecified
TN3064940Medicaid