Provider Demographics
NPI:1447262787
Name:DUFOUR, DENNIS EDWARD (DPH)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:EDWARD
Last Name:DUFOUR
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S 105TH EAST PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-2818
Mailing Address - Country:US
Mailing Address - Phone:918-438-6208
Mailing Address - Fax:
Practice Address - Street 1:4112 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7613
Practice Address - Country:US
Practice Address - Phone:918-743-4491
Practice Address - Fax:918-743-5432
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist