Provider Demographics
NPI:1720181779
Name:TIU, DENNIS L (DMD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:TIU
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 1:1658 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703
Mailing Address - Country:US
Mailing Address - Phone:559-444-0444
Mailing Address - Fax:559-444-0454
Practice Address - Street 1:1658 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703
Practice Address - Country:US
Practice Address - Phone:559-444-0444
Practice Address - Fax:559-444-0454
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91518-01OtherMEDICAL
CAG98011-03OtherHEALTHY FAMILIES