Basic Information
| Provider Information | |||||||||
| NPI: | 1720323710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEY | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | DEENESH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPAS, PA-C, MBBS, | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840026 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062125079 | ||||||||
| FaxNumber: | 8062126278 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 S SONCY RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791196406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063555625 | ||||||||
| FaxNumber: | 8063522245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2012 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA10469 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | PA10469 | 01 | TX | TX MEDICAL BOARD/TX PHYSICIAN ASSISTANT BOARD | OTHER | 1108882 | 01 | NCCPA | OTHER |