Provider Demographics
NPI:1548202260
Name:DENTE, MICHAEL A JR (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:DENTE
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 MCLAWS CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6345
Mailing Address - Country:US
Mailing Address - Phone:757-345-3022
Mailing Address - Fax:757-220-2474
Practice Address - Street 1:356 MCLAWS CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6345
Practice Address - Country:US
Practice Address - Phone:757-345-3022
Practice Address - Fax:757-220-2474
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103-000450213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA145861OtherBLUE CROSS
VA010095816Medicaid
VA37737OtherSENTARA
VA652002OtherMAMSI
VA480028823OtherMEDICARE RAIL ROAD
VA010095816Medicaid
VAU22641Medicare UPIN