Healthcare Provider Details

I. General information

NPI: 1407992480
Provider Name (Legal Business Name): DAVID M KENT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KIRTS BLVD
TROY MI
48084-5251
US

IV. Provider business mailing address

100 KIRTS BLVD
TROY MI
48084-5251
US

V. Phone/Fax

Practice location:
  • Phone: 248-519-9127
  • Fax:
Mailing address:
  • Phone: 248-519-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number228402
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: