MEDICARE: MR. DENNIS DWIGHT DOW M.S.

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	106H00000X	Marriage & Family Therapist	MFC 9598	CA

General Provider Information

NPI Number	:	1538496757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS DWIGHT DOW M.S.

Provider Business Mailing Address
First Line	:	3005 6TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-3611
Country	:	US
Telephone Number	:	916-446-3729
Fax Number	:	916-290-0452

Provider Business Practice Location Address
First Line	:	3005 6TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-3611
Country	:	US
Telephone Number	:	916-446-3729
Fax Number	:	916-290-0452

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

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	11/09/2009

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