Healthcare Provider Details

I. General information

NPI: 1881676146
Provider Name (Legal Business Name): DENNIS PLASTIC SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50B MIDTOWN PARK W
MOBILE AL
36606-4148
US

IV. Provider business mailing address

50B MIDTOWN PARK W
MOBILE AL
36606-4148
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-5114
  • Fax: 251-435-5116
Mailing address:
  • Phone: 251-435-5114
  • Fax: 251-435-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL A DENNNIS III
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 251-435-5114