Provider Demographics
NPI:1457345902
Name:DENNISON, DAVID R (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:DENNISON
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 1:68 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2722
Mailing Address - Country:US
Mailing Address - Phone:828-586-7428
Mailing Address - Fax:828-586-7427
Practice Address - Street 1:68 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2722
Practice Address - Country:US
Practice Address - Phone:828-586-7428
Practice Address - Fax:828-586-7427
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020688207R00000X
NC2000-01479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1457345902Medicaid
GA000190913AAMedicaid
GA000190913ZMedicaid
AL1457345902Medicaid
GA000190913AAMedicaid
NCD29277Medicare UPIN
GA000190913ZMedicaid