Healthcare Provider Details

I. General information

NPI: 1093038630
Provider Name (Legal Business Name): KENT FRANCISCO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29820 BADEN PL
MALIBU CA
90265-3845
US

IV. Provider business mailing address

29820 BADEN PL
MALIBU CA
90265-3845
US

V. Phone/Fax

Practice location:
  • Phone: 310-457-7205
  • Fax:
Mailing address:
  • Phone: 310-457-7205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: