Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 8664 | AL |
NPI | 1013984368 |
---|---|
Provider Name | Dr. Dennis Frank Dase |
First Address | Talladega, AL 35160-2219 |
Second Address | Talladega, AL 35160-2219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 14/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17806 | (05) | AL |
C74703 | (02) | AL |