Provider Demographics
NPI:1518099274
Name:KENT, JOHN N (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:KENT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 LITHO PL STE 300
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2538
Mailing Address - Country:US
Mailing Address - Phone:910-689-1475
Mailing Address - Fax:910-323-0015
Practice Address - Street 1:1031 WEISS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5630
Practice Address - Country:US
Practice Address - Phone:910-689-1475
Practice Address - Fax:910-323-0015
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 61461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994865Medicaid