Provider Demographics
NPI:1730216789
Name:CHANNEL, DENNIS C JR (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:C
Last Name:CHANNEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:912 S GILPIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4521
Mailing Address - Country:US
Mailing Address - Phone:303-778-1312
Mailing Address - Fax:
Practice Address - Street 1:4100 E MISSISSIPPI AVE STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-3051
Practice Address - Country:US
Practice Address - Phone:303-552-9522
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
008163OtherKAISER-COMMERCIAL NUMBER
CO01324185Medicaid