Healthcare Provider Details

I. General information

NPI: 1093818221
Provider Name (Legal Business Name): GARY C DENNIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 PRESTON RD BLDG 3, SUITE 300
PLANO TX
75024-3279
US

IV. Provider business mailing address

PO BOX 6020
FRISCO TX
75035-0225
US

V. Phone/Fax

Practice location:
  • Phone: 214-705-9599
  • Fax: 214-705-9590
Mailing address:
  • Phone: 972-377-9200
  • Fax: 972-377-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD14313
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberF5887
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: