Individual
DR. DEXTER P INNISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
CORNER OF RT N12 AND N7, FORT DEFIANCE, AZ 86504-0649
(770) 760-7566
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
(928) 729-3355
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012791
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
569997178A
—
GA
Enumeration date
12/01/2006
Last updated
03/05/2025
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