Provider Demographics
NPI:1568222552
Name:DENNIS, KENNETH JEROME
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JEROME
Last Name:DENNIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23020 W LORRAINE ST APT 101
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3080
Mailing Address - Country:US
Mailing Address - Phone:734-961-2109
Mailing Address - Fax:
Practice Address - Street 1:23020 W LORRAINE ST APT 101
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-3080
Practice Address - Country:US
Practice Address - Phone:734-961-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide