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General NPI Number Information
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NPI Number | 1720134463
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Entity Type | Individual
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Provider Name | WILLIE DENNIS DMD
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2500 E VAN BUREN ST
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City | PHOENIX
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State | AZ
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Zip | 85008-6037
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Country | US
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Telephone | 602-220-6434
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Fax | 602-629-7330
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Provider Business Mailing Address
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Address Line | 5611 W LINDA LN
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City | CHANDLER
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State | AZ
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Zip | 85226-1889
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Country | US
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Telephone | 602-220-6434
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Fax | 602-629-7330
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2572
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License Number State | AZ
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