Provider Demographics
NPI:1457116790
Name:ROLLEY, DENNIS G
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:G
Last Name:ROLLEY
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 1:2158 VISTA DEL RIO ST
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:CA
Mailing Address - Zip Code:94525-1042
Mailing Address - Country:US
Mailing Address - Phone:510-323-5205
Mailing Address - Fax:
Practice Address - Street 1:2158 VISTA DEL RIO ST
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:CA
Practice Address - Zip Code:94525-1042
Practice Address - Country:US
Practice Address - Phone:510-323-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach