Healthcare Provider Details

I. General information

NPI: 1013984368
Provider Name (Legal Business Name): DENNIS FRANK DASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 STONE AVE
TALLADEGA AL
35160-2219
US

IV. Provider business mailing address

724 STONE AVE
TALLADEGA AL
35160-2219
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-1410
  • Fax: 256-362-0186
Mailing address:
  • Phone: 256-362-1410
  • Fax: 256-362-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8664
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: