Provider Demographics
NPI:1801860234
Name:BETTS, DENNIS A (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:A
Last Name:BETTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 PEERLESS CROSSING
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3784
Mailing Address - Country:US
Mailing Address - Phone:423-339-5656
Mailing Address - Fax:423-339-8889
Practice Address - Street 1:1060 PEERLESS CROSSING
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3784
Practice Address - Country:US
Practice Address - Phone:423-339-5656
Practice Address - Fax:423-339-8889
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029066208000000X
TN29066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45634Medicare UPIN
38104661Medicare PIN