Provider Demographics
NPI:1952469926
Name:DENISON, DOUGLAS RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RAY
Last Name:DENISON
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 1:2430 S ATLANTIC AVE
Mailing Address - Street 2:SUITE D.
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-5437
Mailing Address - Country:US
Mailing Address - Phone:386-255-1633
Mailing Address - Fax:386-253-4994
Practice Address - Street 1:2430 S ATLANTIC AVE
Practice Address - Street 2:SUITE D.
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118-5437
Practice Address - Country:US
Practice Address - Phone:386-255-1633
Practice Address - Fax:386-253-4994
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN117971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice