Healthcare Provider Details

I. General information

NPI: 1023010840
Provider Name (Legal Business Name): JOSEPH MAUGHAN KENT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6421 LYNCH CANYON DR
LAKE ISABELLA CA
93240-9726
US

IV. Provider business mailing address

PO BOX 186
LAKE ISABELLA CA
93240-0186
US

V. Phone/Fax

Practice location:
  • Phone: 760-379-3626
  • Fax:
Mailing address:
  • Phone: 760-379-3625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number25919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: