Provider Demographics
NPI:1730862251
Name:DENNIS, BERTRAND JR
Entity type:Individual
Prefix:
First Name:BERTRAND
Middle Name:
Last Name:DENNIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1105
Mailing Address - Country:US
Mailing Address - Phone:330-322-5582
Mailing Address - Fax:
Practice Address - Street 1:959 AMELIA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1105
Practice Address - Country:US
Practice Address - Phone:330-322-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRM878871347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle