1497743710 NPI number — ROBERT CRAWFORD DENNISON DMD

Table of content: JENNA GRUNDNER LPN (NPI 1093251902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497743710 NPI number — ROBERT CRAWFORD DENNISON DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNISON
Provider First Name:
ROBERT
Provider Middle Name:
CRAWFORD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497743710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 LAPEER AVE
Provider Second Line Business Mailing Address:
HEALTH DELIVERY INC
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-759-6400
Provider Business Mailing Address Fax Number:
989-759-6423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2308 WADSWORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48601-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-792-7771
Provider Business Practice Location Address Fax Number:
989-754-8792
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901009892 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4234625 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 381908328 . This is a "DENTEMAX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88170MI . This is a "OUTER DRIVE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88171MI . This is a "COMMERCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: OO434368 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "DENTAL HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "GOLDEN DENTAL PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "METLIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88123MI . This is a "BAYSIDE" identifier . This identifiers is of the category "OTHER".
  • Identifier: D801095 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "GUARDIAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328020 . This is a "DENTAL BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88096MI . This is a "WADSWORTH" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com