Healthcare Provider Details

I. General information

NPI: 1346321056
Provider Name (Legal Business Name): ROBERT STEVEN DENNIS PH.D., CRC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST BLDG 410, ROOM 322
DAYTON OH
45428-9000
US

IV. Provider business mailing address

311 W NORMAN AVE #1
DAYTON OH
45405-3343
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-262-5960
Mailing address:
  • Phone: 937-268-6511
  • Fax: 937-262-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: