1689723959 NPI number — BRUCE W DENNIS MD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689723959 NPI number — BRUCE W DENNIS MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUCE W DENNIS MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADA ADULT MEDICINE CLINIC
Provider Other Organization Name Type Code:
3
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:
1689723959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 ARLINGTON CTR
Provider Second Line Business Mailing Address:
PMB 224
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74820-2883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-272-0025
Provider Business Mailing Address Fax Number:
580-272-6559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 BETTER NOW PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74820-2279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-272-0025
Provider Business Practice Location Address Fax Number:
580-272-6559
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DENNIS
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
580-272-0025

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  18405 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200034380A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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