MEDICARE: MR. KENNETH D DENTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL8163H	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154689586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH D DENTON

Provider Business Mailing Address
First Line	:	2314 E TOPEKA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-2438
Country	:	US
Telephone Number	:	480-347-0215
Fax Number	:	480-347-0270

Provider Business Practice Location Address
First Line	:	2314 E TOPEKA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-2438
Country	:	US
Telephone Number	:	480-347-0215
Fax Number	:	480-347-0270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	04/23/2012

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Directions to “ MR. KENNETH D DENTON ” Practice Location

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