Provider Demographics
NPI:1568475226
Name:DENSON, TODD RANDAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:RANDAL
Last Name:DENSON
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 1:2191 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2577
Mailing Address - Country:US
Mailing Address - Phone:321-269-5701
Mailing Address - Fax:321-268-0691
Practice Address - Street 1:2191 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2577
Practice Address - Country:US
Practice Address - Phone:321-269-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1309103511223G0001X
FL132981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice