Healthcare Provider Details

I. General information

NPI: 1053773077
Provider Name (Legal Business Name): DEBBIE DENNIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 S VAL VISTA DR
GILBERT AZ
85297-7000
US

IV. Provider business mailing address

1901 E PARK AVE
GILBERT AZ
85234-6107
US

V. Phone/Fax

Practice location:
  • Phone: 480-397-2800
  • Fax:
Mailing address:
  • Phone: 480-577-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number008521
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: