Basic Information
| Provider Information | |||||||||
| NPI: | 1649256561 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENNIS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E HAMPDEN AVE | ||||||||
| Address2: | NO 100 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801133781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 23198 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 25104 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-36688 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD17507 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1649256561 | 05 | MO | MEDICAID | 1649256561 | 05 | IA | MEDICAID | 0224905 | 05 | WA | MEDICAID | 10025709000 | 05 | NE | MEDICAID | 1649256561 | 05 | CA | MEDICAID | 2301381 | 05 | LA | MEDICAID | 84-059792913 | 05 | NE | MEDICAID | 200364600 | 05 | IN | MEDICAID | 64048556 | 05 | KY | MEDICAID | 104699390 | 05 | MI | MEDICAID | 1649256561 | 05 | WY | MEDICAID | 208221601 | 05 | TX | MEDICAID | 42866602 | 05 | AZ | MEDICAID | 200067205 | 05 | MO | MEDICAID | 200638130A | 05 | OK | MEDICAID | 01231984 | 05 | CO | MEDICAID | 1649256561 | 05 | MT | MEDICAID | 200425880A | 05 | KS | MEDICAID | 23727055 | 05 | NM | MEDICAID |