Healthcare Provider Details

I. General information

NPI: 1316949332
Provider Name (Legal Business Name): MICHAEL S DENTON PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 COYLE AVE STE 202
CARMICHAEL CA
95608-6337
US

IV. Provider business mailing address

6403 COYLE AVE STE 170
CARMICHAEL CA
95608-0363
US

V. Phone/Fax

Practice location:
  • Phone: 916-961-3434
  • Fax: 916-961-0540
Mailing address:
  • Phone: 916-965-4000
  • Fax: 916-965-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: