MEDICARE: DR. MONTA CUTBIRTH KENNADY DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	14037	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	813315	OTHER	TX	UNITED CONCORDIA
3	84V342	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1144216599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONTA CUTBIRTH KENNADY DDS

Provider Business Mailing Address
First Line	:	1505 EMERALD PLAZA
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-1501
Country	:	US
Telephone Number	:	979-764-7101
Fax Number	:	979-764-7115

Provider Business Practice Location Address
First Line	:	1505 EMERALD PLAZA
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-1501
Country	:	US
Telephone Number	:	979-764-7101
Fax Number	:	979-764-7115

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	09/07/2010

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Directions to “ DR. MONTA CUTBIRTH KENNADY DDS” Practice Location

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