Provider Demographics
NPI:1194476069
Name:BOATWRIGHT, DENNIS SAMUEL JR
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:SAMUEL
Last Name:BOATWRIGHT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15700 W 10 MILE RD STE 212
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2143
Mailing Address - Country:US
Mailing Address - Phone:313-397-8159
Mailing Address - Fax:313-397-8159
Practice Address - Street 1:15700 W 10 MILE RD STE 212
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2143
Practice Address - Country:US
Practice Address - Phone:313-397-8159
Practice Address - Fax:313-397-8159
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)