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General NPI Number Information
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NPI Number | 1407019706
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Entity Type | Organization
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Legal Business Name | DENNIS DEJESUS MD PA
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 125 BEAVER DAM RD
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City | COLUMBIA
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State | SC
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Zip | 29223-3101
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Country | US
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Telephone | 816-536-2300
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Fax | 866-596-5119
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Provider Business Mailing Address
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Address Line | 6324 N CHATHAM AVE
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City | KANSAS CITY
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State | MO
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Zip | 64151-2473
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Country | US
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Telephone | 816-536-2300
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Fax | 866-596-5119
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS DEJESUS
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Credential | M.D.
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Telephone | 816-536-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 26223
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License Number State | OK
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