Provider Demographics
NPI:1740268861
Name:DENNIS, KEVIN ODELL (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ODELL
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2000 MALLORY LN
Mailing Address - Street 2:SUITE 130-256
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8209
Mailing Address - Country:US
Mailing Address - Phone:615-598-1289
Mailing Address - Fax:615-778-1327
Practice Address - Street 1:2000 MALLORY LN
Practice Address - Street 2:SUITE 130-256
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8209
Practice Address - Country:US
Practice Address - Phone:615-598-1289
Practice Address - Fax:615-778-1327
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN37294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3885919Medicaid
TN3885919Medicaid
TNH96142Medicare UPIN