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General NPI Number Information
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NPI Number | 1932102944
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Entity Type | Individual
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Provider Name | DENNIS SAMUEL JR. MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 350 STEELES RD
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City | BRISTOL
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State | TN
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Zip | 37620-9532
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Country | US
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Telephone | 423-844-4925
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Fax | 423-844-4933
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | KINGSPORT
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State | TN
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Zip | 37662-0009
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Country | US
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Telephone | 423-857-2066
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Fax | 423-857-2070
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101050784
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD 27665
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License Number State | TN
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