Provider Demographics
NPI:1538381363
Name:DENNIS, IAN C (DMD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:C
Last Name:DENNIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643
Mailing Address - Country:US
Mailing Address - Phone:386-454-1412
Mailing Address - Fax:386-454-2412
Practice Address - Street 1:60 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643
Practice Address - Country:US
Practice Address - Phone:386-454-1412
Practice Address - Fax:386-454-2412
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist