MEDICARE: JOSEPH M KENT DDS INC.

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	122300000X	Dentist		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B25919	OTHER	CA	DENTAL LIC

General Provider Information

NPI Number	:	1184040610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH M KENT DDS INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 186
Second Line	:
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240
Country	:	US
Telephone Number	:	760-379-3625
Fax Number	:	760-230-9165

Provider Business Practice Location Address
First Line	:	6421 LYNCH CANYON DRIVE
Second Line	:
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240
Country	:	US
Telephone Number	:	760-379-3625
Fax Number	:	760-230-9165

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH MAUGHAN KENT
Credential	:	D.D.S.
Telephone Number	:	760-379-3625

Provider Enumeration Date	:	03/07/2014
Last Update Date	:	11/08/2019

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