1497743710 NPI number — ROBERT CRAWFORD DENNISON DMD

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

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 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:

1497743710

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/05/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 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

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• 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" .

• 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".