Provider Demographics
NPI:1093837619
Name:ROY E DENTON MD PA
Entity Type:Organization
Organization Name:ROY E DENTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLIING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-737-3071
Mailing Address - Street 1:1138 N GERMANTOWN PKWY # 101-377
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5872
Mailing Address - Country:US
Mailing Address - Phone:901-737-3071
Mailing Address - Fax:901-328-1888
Practice Address - Street 1:2210 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4943
Practice Address - Country:US
Practice Address - Phone:501-932-3500
Practice Address - Fax:501-932-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116106001Medicaid
AR116106001Medicaid
C51860Medicare UPIN
ARC7072Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
AR116106001Medicaid