Provider Demographics
NPI:1235875287
Name:DENT, MILTON JAMES JR
Entity Type:Individual
Prefix:MR
First Name:MILTON
Middle Name:JAMES
Last Name:DENT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1391
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-4391
Mailing Address - Country:US
Mailing Address - Phone:708-252-3705
Mailing Address - Fax:
Practice Address - Street 1:24 PEYTON DR
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1183
Practice Address - Country:US
Practice Address - Phone:708-466-2408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty