Provider Demographics
NPI:1306936919
Name:HOMER, DENNY WILLIS (DMD)
Entity type:Individual
Prefix:DR
First Name:DENNY
Middle Name:WILLIS
Last Name:HOMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-0151
Mailing Address - Country:US
Mailing Address - Phone:509-422-3200
Mailing Address - Fax:509-422-2339
Practice Address - Street 1:108 SECOND AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:OKANOGAN
Practice Address - State:WA
Practice Address - Zip Code:98840-0151
Practice Address - Country:US
Practice Address - Phone:509-422-3200
Practice Address - Fax:509-422-2339
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000046241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice