Provider Demographics
NPI:1710058862
Name:DENISON, JOHN FREDRIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDRIC
Last Name:DENISON
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 1:2036 REGENCY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2309
Mailing Address - Country:US
Mailing Address - Phone:859-277-6234
Mailing Address - Fax:859-276-3726
Practice Address - Street 1:2036 REGENCY RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2309
Practice Address - Country:US
Practice Address - Phone:859-277-6234
Practice Address - Fax:859-276-3726
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice