Provider Demographics
NPI:1376609958
Name:DENT, AARON (DO)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:DENT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 CASTLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-1764
Mailing Address - Country:US
Mailing Address - Phone:636-578-0067
Mailing Address - Fax:
Practice Address - Street 1:515 COWAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-4604
Practice Address - Country:US
Practice Address - Phone:417-533-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007001556207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1376609958Medicaid
MOP01085136OtherMCR RR
MO431560263OtherTRICARE
MO431560263OtherTRICARE