Provider Demographics
NPI:1114148996
Name:WILLIAM W DENT MDPA
Entity Type:Organization
Organization Name:WILLIAM W DENT MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-763-8680
Mailing Address - Street 1:801 E 6TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3667
Mailing Address - Country:US
Mailing Address - Phone:850-763-8680
Mailing Address - Fax:850-763-8690
Practice Address - Street 1:801 E 6TH ST STE 201
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3667
Practice Address - Country:US
Practice Address - Phone:850-763-8680
Practice Address - Fax:850-763-8690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050306174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50691Medicare UPIN
FLK7890Medicare ID - Type Unspecified