Provider Demographics
NPI:1831686476
Name:DENT, DONALD KIRK II
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:KIRK
Last Name:DENT
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 BRAMBLETON AVE STE 201A
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6527
Mailing Address - Country:US
Mailing Address - Phone:540-266-7550
Mailing Address - Fax:
Practice Address - Street 1:3433 BRAMBLETON AVE STE 201A
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6527
Practice Address - Country:US
Practice Address - Phone:540-266-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194996280Medicaid