MEDICARE: BRUCE E. DENNINGS, PH.D.

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	103T00000X	Psychologist	33-508	MS

General Provider Information

NPI Number	:	1477712198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE E. DENNINGS, PH.D.

Provider Business Mailing Address
First Line	:	2112 BIENVILLE BLVD
Second Line	:	SUITE O-1
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3052
Country	:	US
Telephone Number	:	228-875-8440
Fax Number	:	228-875-8443

Provider Business Practice Location Address
First Line	:	2112 BIENVILLE BLVD
Second Line	:	SUITE O-1
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3052
Country	:	US
Telephone Number	:	228-875-8440
Fax Number	:	228-875-8443

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRUCE ELDON DENNINGS
Credential	:	PH.D
Telephone Number	:	228-875-8440

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	06/06/2008

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