Provider Demographics
NPI:1124255583
Name:DENNIS, DANNY LEE JR (IDMT)
Entity type:Individual
Prefix:MR
First Name:DANNY
Middle Name:LEE
Last Name:DENNIS
Suffix:JR
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 GREENTREE AVE.
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306
Mailing Address - Country:US
Mailing Address - Phone:334-546-7379
Mailing Address - Fax:
Practice Address - Street 1:939 MISSILE ROAD BLD 1900
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians