MEDICARE: DR. DENNIS ALAN HISE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4264	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61-0975938	OTHER		TAX ID #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275699233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS ALAN HISE DMD

Provider Business Mailing Address
First Line	:	PO BOX 104; 1028 NORTH COLLEGE ST
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-0104
Country	:	US
Telephone Number	:	859-734-5437
Fax Number	:	859-715-0818

Provider Business Practice Location Address
First Line	:	PO BOX 104; 1028 NORTH COLLEGE ST
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-0104
Country	:	US
Telephone Number	:	859-734-5437
Fax Number	:	859-715-0818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	11/16/2016

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