Healthcare Provider Details

I. General information

NPI: 1275739559
Provider Name (Legal Business Name): ROBERT KENT MS, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 BRIER CREEK PARKWAY SUITE 100
RALEIGH NC
27617
US

IV. Provider business mailing address

7780 BRIER CREEK PARKWAY SUITE 100
RALEIGH NC
27617
US

V. Phone/Fax

Practice location:
  • Phone: 919-957-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5557
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: