Provider Demographics
NPI:1912183146
Name:DENNIS S. DAVIS
Entity Type:Organization
Organization Name:DENNIS S. DAVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-667-1910
Mailing Address - Street 1:903 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-4876
Mailing Address - Country:US
Mailing Address - Phone:970-667-1910
Mailing Address - Fax:970-667-1914
Practice Address - Street 1:903 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4876
Practice Address - Country:US
Practice Address - Phone:970-667-1910
Practice Address - Fax:970-667-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5960261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty