Healthcare Provider Details

I. General information

NPI: 1720307671
Provider Name (Legal Business Name): MR. JOHN DENNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 BOSTON ST
DANVILLE AR
72833
US

IV. Provider business mailing address

PO BOX 1042
DANVILLE AR
72833-1042
US

V. Phone/Fax

Practice location:
  • Phone: 479-495-5177
  • Fax: 479-495-5178
Mailing address:
  • Phone: 479-495-5177
  • Fax: 479-495-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: