Provider Demographics
NPI:1790265429
Name:DIGNAN, DENNIS J
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:DIGNAN
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 1:144 GLEN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-3396
Mailing Address - Country:US
Mailing Address - Phone:608-437-5698
Mailing Address - Fax:
Practice Address - Street 1:144 GLEN VIEW RD
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-3396
Practice Address - Country:US
Practice Address - Phone:608-437-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6457171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI171WH0202XMedicaid