Healthcare Provider Details

I. General information

NPI: 1275684110
Provider Name (Legal Business Name): DEAN B KENT MS CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8313 CASS ST
OMAHA NE
68114-3529
US

IV. Provider business mailing address

8313 CASS ST
OMAHA NE
68114-3529
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-0811
  • Fax:
Mailing address:
  • Phone: 402-391-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number191
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number618
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number00842
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number366A
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: