Healthcare Provider Details

I. General information

NPI: 1689657629
Provider Name (Legal Business Name): KYLE CAMERON DENNIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

12836 SILVIA LOOP
WOODBRIDGE VA
22192-5093
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8379
  • Fax: 202-745-8579
Mailing address:
  • Phone: 202-745-8379
  • Fax: 202-745-8579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: