DENNIS, MARK A (MD)

Provider Demographics

• NPI: 1649256561
• Name: DENNIS, MARK A (MD)
• Entity type: Individual
• Prefix: DR
• First Name: MARK
• Middle Name: A
• Last Name: DENNIS
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 10800 E GEDDES AVE STE 300
• Practice Address - City: ENGLEWOOD
• Practice Address - State: CO
• Practice Address - Zip Code: 80112-3895
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: No
• Enumeration Date: 2005-12-22
• Last Update Date: 2022-12-14

Provider Licenses

State	License ID	Taxonomies
NE	25104	2085R0202X
KS	04-36688	2085R0202X
HI	MD17507	2085R0202X
CO	23198	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NE	10025709000	Medicaid
LA	2301381	Medicaid
WY	1649256561	Medicaid
IA	1649256561	Medicaid
IN	200364600	Medicaid
NM	23727055	Medicaid
CO	01231984	Medicaid
AZ	42866602	Medicaid
KY	64048556	Medicaid
MI	104699390	Medicaid
MT	1649256561	Medicaid
MO	1649256561	Medicaid
KS	200425880A	Medicaid
CA	1649256561	Medicaid
OK	200638130A	Medicaid
WA	0224905	Medicaid
MO	200067205	Medicaid
TX	208221601	Medicaid
NE	84-059792913	Medicaid
AZ	42866602	Medicaid
MO	1649256561	Medicaid
KS	200425880A	Medicaid
NE	CO305885	Medicare PIN
CO	393390ZLJ3	Medicare PIN
IL	$$$$$$$$$	Medicaid
IA	1649256561	Medicaid
WY	1649256561	Medicaid
KS	111257056	Medicare PIN
TX	208221601	Medicaid
WA	0224905	Medicaid
CO	D24232	Medicare UPIN
KS	P01400382	Medicare PIN
NE	NA2517022	Medicare PIN
NE	NA1214053	Medicare PIN