Provider Demographics
NPI:1952497299
Name:DENTON, DALE KENNETH JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:KENNETH
Last Name:DENTON
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 HATTON COVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7395
Mailing Address - Country:US
Mailing Address - Phone:901-850-9390
Mailing Address - Fax:901-850-9519
Practice Address - Street 1:205 W MAPLE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4026
Practice Address - Country:US
Practice Address - Phone:580-548-1106
Practice Address - Fax:580-233-8802
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0086924367500000X
TN9454367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3604755Medicaid
TN3604755Medicaid