Provider Demographics
NPI:1902083876
Name:DR. KENT S. DENTON
Entity Type:Organization
Organization Name:DR. KENT S. DENTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:SWINDELL
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-566-9616
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-0008
Mailing Address - Country:US
Mailing Address - Phone:252-566-9616
Mailing Address - Fax:252-566-4910
Practice Address - Street 1:515 S CASWELL ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:NC
Practice Address - Zip Code:28551-2005
Practice Address - Country:US
Practice Address - Phone:252-566-9616
Practice Address - Fax:252-566-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
92125OtherBLUE CROSS BLUE SHIELD
816475OtherUNITED CONCORDIA
NC8992125Medicaid