Provider Demographics
NPI:1912542713
Name:MICHAEL A DENTE JR DPM PLC
Entity Type:Organization
Organization Name:MICHAEL A DENTE JR DPM PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-358-3183
Mailing Address - Street 1:356 MCLAWS CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6345
Mailing Address - Country:US
Mailing Address - Phone:757-358-3183
Mailing Address - Fax:
Practice Address - Street 1:356 MCLAWS CIR STE 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6345
Practice Address - Country:US
Practice Address - Phone:757-358-3183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty