Provider Demographics
NPI:1215681788
Name:DENNENBERG, DANI HY (LAC)
Entity type:Individual
Prefix:
First Name:DANI
Middle Name:HY
Last Name:DENNENBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 SE DIVISION ST STE 315
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4673
Mailing Address - Country:US
Mailing Address - Phone:503-894-9437
Mailing Address - Fax:
Practice Address - Street 1:959 SE DIVISION ST STE 315
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4673
Practice Address - Country:US
Practice Address - Phone:503-894-9437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR209367171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist