Provider Demographics
NPI:1881710820
Name:DENNIS ALAN HISE, PSC
Entity type:Organization
Organization Name:DENNIS ALAN HISE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY,TREASURER,OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:HISE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, BHS
Authorized Official - Phone:859-734-5437
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:1028 NORTH COLLEGE ST.
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-0104
Mailing Address - Country:US
Mailing Address - Phone:859-734-5437
Mailing Address - Fax:859-734-5437
Practice Address - Street 1:1028 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-2227
Practice Address - Country:US
Practice Address - Phone:859-734-5437
Practice Address - Fax:859-734-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6194092000Medicaid
KY9724Medicare ID - Type Unspecified