Provider Demographics
NPI:1558415653
Name:TRENT, EARNEST LEON JR
Entity Type:Individual
Prefix:
First Name:EARNEST
Middle Name:LEON
Last Name:TRENT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 380
Mailing Address - Street 2:1093 2ND ST
Mailing Address - City:MASON
Mailing Address - State:WV
Mailing Address - Zip Code:25260
Mailing Address - Country:US
Mailing Address - Phone:304-773-5620
Mailing Address - Fax:304-773-6064
Practice Address - Street 1:1093 2ND ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:WV
Practice Address - Zip Code:25260
Practice Address - Country:US
Practice Address - Phone:304-773-5620
Practice Address - Fax:304-773-6064
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist