Provider Demographics
NPI:1558363341
Name:DENTON, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:DENTON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1151 HOSPITAL WAY
Mailing Address - Street 2:BUILDING F
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5091
Mailing Address - Country:US
Mailing Address - Phone:208-232-1443
Mailing Address - Fax:208-239-3434
Practice Address - Street 1:1151 HOSPITAL WAY
Practice Address - Street 2:BUILDING F
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5091
Practice Address - Country:US
Practice Address - Phone:208-232-1443
Practice Address - Fax:208-239-3434
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
IDM-75862080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805197600Medicaid
IDG79449Medicare UPIN