Provider Demographics
NPI:1700873288
Name:KENT, HOLLY DORIS (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:DORIS
Last Name:KENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E HARVARD AVE #320
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7005
Mailing Address - Country:US
Mailing Address - Phone:303-777-5006
Mailing Address - Fax:303-777-5079
Practice Address - Street 1:950 E HARVARD AVE #320
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7005
Practice Address - Country:US
Practice Address - Phone:303-777-5006
Practice Address - Fax:303-777-5079
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30754207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01307545Medicaid
COC528738Medicare PIN
COC495458Medicare PIN
COP0068506Medicare PIN
E60709Medicare UPIN