Basic Information
| Provider Information | |||||||||
| NPI: | 1376650408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALES | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 KIRBY DR | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770983900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137982091 | ||||||||
| FaxNumber: | 7137983644 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 E 3RD ST UNIT 201 | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813015759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707641790 | ||||||||
| FaxNumber: | 9703757927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 07/17/2019 | ||||||||
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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 | 207Q00000X | L4793 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DR.0040200 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.