Provider Demographics
NPI:1104302819
Name:DENT, TIKIA MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:TIKIA
Middle Name:MICHELLE
Last Name:DENT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6059 LAKE CLUB PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3156
Mailing Address - Country:US
Mailing Address - Phone:937-840-8003
Mailing Address - Fax:
Practice Address - Street 1:6059 LAKE CLUB PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3156
Practice Address - Country:US
Practice Address - Phone:937-840-8003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH449881163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse