Individual
EDWARD DENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
406 SUNRISE AVE STE 300, ROSEVILLE, CA 95661-4106
(530) 470-2425
Mailing address
10041 LODE LINE WAY, GRASS VALLEY, CA 95949-9296
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
37564
CA
Other
Enumeration date
10/20/2021
Last updated
10/20/2021
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