Provider Demographics
NPI:1972613180
Name:DENTON, ALICE M (MD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:M
Last Name:DENTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:330-725-3009
Mailing Address - Fax:330-722-7502
Practice Address - Street 1:4001 CARRICK DR STE 210
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5393
Practice Address - Country:US
Practice Address - Phone:330-725-3009
Practice Address - Fax:330-722-7502
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2084971Medicaid
OH0829292Medicare PIN
G55522Medicare UPIN