Healthcare Provider Details

I. General information

NPI: 1033156492
Provider Name (Legal Business Name): LEE DENNIS, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 FOREST ST
DOVER DE
19904-3470
US

IV. Provider business mailing address

1602 NEWPORT GAP PIKE
WILMINGTON DE
19808-6208
US

V. Phone/Fax

Practice location:
  • Phone: 302-735-1888
  • Fax:
Mailing address:
  • Phone: 302-633-5840
  • Fax: 302-633-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC-0002705
License Number StateDE

VIII. Authorized Official

Name: LOUISE DEMBY
Title or Position: OFFICE MANAGER
Credential:
Phone: 302-735-1888