MEDICARE: DR. KATHLEEN MCGARR BENNETT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	41354	CA

General Provider Information

NPI Number	:	1033260278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN MCGARR BENNETT D.D.S.

Provider Business Mailing Address
First Line	:	6149 LAKE LINDERO DR
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4640
Country	:	US
Telephone Number	:	818-991-9244
Fax Number	:

Provider Business Practice Location Address
First Line	:	28040 DOROTHY DR STE 203
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4916
Country	:	US
Telephone Number	:	818-889-4448
Fax Number	:	818-889-0206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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