Provider Demographics
NPI:1245765015
Name:DENT, EDWARD ALEXANDER (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALEXANDER
Last Name:DENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 CLIFTON RD NE RM H-184
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-727-8657
Mailing Address - Fax:
Practice Address - Street 1:100 WOODRUFF CIR NE
Practice Address - Street 2:SUITE 327
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1020
Practice Address - Country:US
Practice Address - Phone:404-727-5658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800971896390200000X
GA89383207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program