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General NPI Number Information
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NPI Number | 1629410444
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Entity Type | Organization
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Legal Business Name | DENNIS U ATIENZA DO LLC
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 1401 MEMORIAL AVE SUITE B
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City | WASHINGTON
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State | IN
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Zip | 47501-3153
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Country | US
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Telephone | 812-254-2400
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Fax | 812-254-3191
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Provider Business Mailing Address
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Address Line | 1401 MEMORIAL AVE SUITE B
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City | WASHINGTON
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State | IN
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Zip | 47501-3153
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Country | US
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Telephone | 812-254-2400
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Fax | 812-254-3191
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Authorized Official
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Title or Position | OWNER
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Name | DENNIS U ATIENZA
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Credential | DO
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Telephone | 812-254-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0200425A
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License Number State | IN
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