Provider Demographics
NPI:1447344635
Name:DENTON, CAROLYN DALE (DO)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DALE
Last Name:DENTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 N RIEDEL ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78164-1810
Mailing Address - Country:US
Mailing Address - Phone:361-564-9230
Mailing Address - Fax:361-564-9246
Practice Address - Street 1:508 N RIEDEL ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:TX
Practice Address - Zip Code:78164-1810
Practice Address - Country:US
Practice Address - Phone:361-564-9230
Practice Address - Fax:361-564-9246
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1F5097OtherMEDICARE
TX155386908Medicaid
TX155386908Medicaid
TX155386908Medicaid
KYBD8038146OtherDEA