Provider Demographics
NPI:1821718859
Name:DENTEN, KENAN LEROY (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:KENAN
Middle Name:LEROY
Last Name:DENTEN
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
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 97
Mailing Address - Street 2:
Mailing Address - City:BOISE CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73933-0097
Mailing Address - Country:US
Mailing Address - Phone:580-544-3441
Mailing Address - Fax:405-767-0905
Practice Address - Street 1:318 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOISE CITY
Practice Address - State:OK
Practice Address - Zip Code:73933-9607
Practice Address - Country:US
Practice Address - Phone:580-544-3441
Practice Address - Fax:405-767-0905
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist