Provider Demographics
NPI:1134479462
Name:KENT PEDIATRICS, LLC
Entity Type:Organization
Organization Name:KENT PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARIZZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-264-9691
Mailing Address - Street 1:1102 S DUPONT HWY
Mailing Address - Street 2:STE 1
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4493
Mailing Address - Country:US
Mailing Address - Phone:302-264-9691
Mailing Address - Fax:302-264-9920
Practice Address - Street 1:1102 S DUPONT HWY
Practice Address - Street 2:STE 1
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4493
Practice Address - Country:US
Practice Address - Phone:302-264-9691
Practice Address - Fax:302-264-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007064208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty