Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | NC3438 | NC |
Y | 213EG0000X | General Practice | NC3438 | NC |
NPI | 1003941899 |
---|---|
Provider Name | Dr. Kent S. Denton |
First Address | La Grange, NC 28551-0008 |
Second Address | La Grange, NC 28551-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
816475 | UNITED CONCORDIA (01) | NC |
8992125 | (05) | NC |
92125 | BCBS (01) | NC |