Provider Demographics
NPI:1437352291
Name:KENT, DANA MICHELE (LD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELE
Last Name:KENT
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LD
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-619-4300
Mailing Address - Fax:918-619-4322
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:1ST FLOOR, STE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-619-4800
Practice Address - Fax:918-619-4801
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1502133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered