Provider Demographics
NPI:1174729776
Name:DENNIS, DAVID SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:DENNIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1239
Mailing Address - Country:US
Mailing Address - Phone:909-796-5199
Mailing Address - Fax:909-796-2950
Practice Address - Street 1:11354 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3855
Practice Address - Country:US
Practice Address - Phone:909-796-5199
Practice Address - Fax:909-796-2950
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330324481OtherTAX I.D #
776400OtherUNITED CONCORDIA INSURANC