Healthcare Provider Details

I. General information

NPI: 1033299987
Provider Name (Legal Business Name): DENNIS SALE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 S NATIONAL AVE STE 110
SPRINGFIELD MO
65804-4268
US

IV. Provider business mailing address

3045 S NATIONAL AVE STE 110
SPRINGFIELD MO
65804-4268
US

V. Phone/Fax

Practice location:
  • Phone: 417-888-6790
  • Fax:
Mailing address:
  • Phone: 417-888-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0528427
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017038663
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: