Provider Demographics
NPI:1154689586
Name:DENTON, KENNETH D
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:D
Last Name:DENTON
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:LEAH
Other - Middle Name:A
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2314 E TOPEKA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-2438
Mailing Address - Country:US
Mailing Address - Phone:480-347-0215
Mailing Address - Fax:480-347-0270
Practice Address - Street 1:2314 E TOPEKA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-2438
Practice Address - Country:US
Practice Address - Phone:480-347-0215
Practice Address - Fax:480-347-0270
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8163H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ675355Medicaid