Healthcare Provider Details

I. General information

NPI: 1245750231
Provider Name (Legal Business Name): PATRICK BRYAN DENNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 LYNDHURST AVE
WINSTON SALEM NC
27103-4005
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-5221
  • Fax: 336-765-0430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL51288
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2022-01473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: