Provider Demographics
NPI:1902997612
Name:DENNINGTON, DONALD C (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:C
Last Name:DENNINGTON
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4401
Mailing Address - Country:US
Mailing Address - Phone:573-334-5077
Mailing Address - Fax:573-334-7379
Practice Address - Street 1:2103 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4401
Practice Address - Country:US
Practice Address - Phone:573-334-5077
Practice Address - Fax:573-334-7379
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO43-19086461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43-1908646OtherTAX ID