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General NPI Number Information
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NPI Number | 1326044603
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Entity Type | Individual
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Provider Name | DENNIS DODD CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 5602 SW LEE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-9635
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Country | US
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Telephone | 580-531-4727
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 571
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City | ALTUS
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State | OK
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Zip | 73522-0571
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Country | US
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Telephone | 580-481-4815
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R0040475
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License Number State | OK
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