Provider Demographics
NPI:1316149255
Name:EGNATZ, DENNIS GRANT (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GRANT
Last Name:EGNATZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1386 WESTGATE CENTER DR STE C
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1386 WESTGATE CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3103
Practice Address - Country:US
Practice Address - Phone:336-765-9995
Practice Address - Fax:336-765-9995
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-016942083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE39965Medicare UPIN