Provider Demographics
NPI:1588672489
Name:CLOSE, DENNIS C (DDS)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:C
Last Name:CLOSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 KERRY FOREST PARKWAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309
Mailing Address - Country:US
Mailing Address - Phone:850-893-8988
Mailing Address - Fax:850-893-3196
Practice Address - Street 1:2929 KERRY FOREST PARKWAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309
Practice Address - Country:US
Practice Address - Phone:850-893-8988
Practice Address - Fax:850-893-3196
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist