Provider Demographics
NPI:1871518548
Name:DENT, JEFFREY WILLIAM LEWIS (PA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WILLIAM LEWIS
Last Name:DENT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 FORT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3941
Mailing Address - Country:US
Mailing Address - Phone:810-987-9871
Mailing Address - Fax:810-987-6050
Practice Address - Street 1:600 FORT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3941
Practice Address - Country:US
Practice Address - Phone:810-987-9871
Practice Address - Fax:810-987-6050
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004138363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical