Provider Demographics
NPI:1821121112
Name:DENT, MARENDA D (DO)
Entity Type:Individual
Prefix:
First Name:MARENDA
Middle Name:D
Last Name:DENT
Suffix:
Gender:F
Credentials:DO
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 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:888-873-9595
Mailing Address - Fax:877-473-8164
Practice Address - Street 1:7800 SHOAL CREEK BLVD STE 130W
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1040
Practice Address - Country:US
Practice Address - Phone:512-407-8880
Practice Address - Fax:512-407-8681
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01913207Q00000X
TXM7795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2832404-01Medicaid
NC5906305Medicaid
NC2075729CMedicare PIN
NC2075729Medicare PIN
NC5906305Medicaid
TX2832404-01Medicaid
NC2075729BMedicare PIN
NC2075729AMedicare PIN
NC2075729EMedicare PIN