Provider Demographics
NPI:1538496757
Name:DOW, DENNIS DWIGHT (MS)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:DWIGHT
Last Name:DOW
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3611
Mailing Address - Country:US
Mailing Address - Phone:916-446-3729
Mailing Address - Fax:916-290-0452
Practice Address - Street 1:3005 6TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-3611
Practice Address - Country:US
Practice Address - Phone:916-446-3729
Practice Address - Fax:916-290-0452
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 9598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist