Provider Demographics
NPI:1720323710
Name:DEY, DENNIS DEENESH (MPAS, PA-C, MBBS,)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:DEENESH
Last Name:DEY
Suffix:
Gender:M
Credentials:MPAS, PA-C, MBBS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-5079
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:3501 S SONCY RD STE 140
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6406
Practice Address - Country:US
Practice Address - Phone:806-355-5625
Practice Address - Fax:806-352-2245
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10469363AS0400X, 363AS0400X
NVPA1408363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA10469OtherTX MEDICAL BOARD/TX PHYSICIAN ASSISTANT BOARD
1108882OtherNCCPA
AZ5315OtherARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANT LICENSE NUMBER
1108882OtherNCCPA