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General NPI Number Information
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NPI Number | 1205805850
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Entity Type | Individual
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Provider Name | KARL M DENNIS PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 2090 WOODWINDS DR
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City | WOODBURY
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State | MN
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Zip | 55125
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Country | US
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Telephone | 651-968-5801
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Fax | 651-968-5899
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Provider Business Mailing Address
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Address Line | PO BOX 86 SDS 12 2901
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-2901
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Country | US
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Telephone | 651-968-5050
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Fax | 651-968-5900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 9979
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License Number State | MN
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