Individual
KEVIN MICHAEL DENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-4900
Mailing address
PO BOX 6048, BEND, OR 97708-6048
(541) 382-4900
(503) 236-0786
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA156037
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500639220
—
OR
Enumeration date
09/26/2011
Last updated
01/10/2022
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