Provider Demographics
NPI:1336205996
Name:STRUVE, DENNIS DALE (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:DALE
Last Name:STRUVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 ASH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4585
Mailing Address - Country:US
Mailing Address - Phone:530-257-9597
Mailing Address - Fax:
Practice Address - Street 1:151 ASH ST STE A
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4585
Practice Address - Country:US
Practice Address - Phone:530-257-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice