Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN8682 | FL |
NPI | 1063478717 |
---|---|
Provider Name | Dr. Matthew J Dennis |
First Address | Gainesville, FL 32610-0425 |
Second Address | Gainesville, FL 32610-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AD1272575 | DEA (01) | FL |
T84320 | (02) | FL |