Provider Demographics
NPI:1841876489
Name:DENT, TEVIN ELLIOTT (LAT, ATC)
Entity type:Individual
Prefix:
First Name:TEVIN
Middle Name:ELLIOTT
Last Name:DENT
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 BISCAYNE BEND LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6219
Mailing Address - Country:US
Mailing Address - Phone:832-314-9521
Mailing Address - Fax:
Practice Address - Street 1:702 GREENBRIAR DRIVE
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5308
Practice Address - Country:US
Practice Address - Phone:713-542-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT80172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty