MEDICARE: DR. KENNETH THOMAS BEZAN DMD

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	1223E0200X	Endodontics	4342	OK

General Provider Information

NPI Number	:	1598707895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH THOMAS BEZAN DMD

Provider Business Mailing Address
First Line	:	5555 E 71ST ST
Second Line	:	SUITE 9210
City	:	TULSA
State	:	OK
Zip	:	74136-6542
Country	:	US
Telephone Number	:	918-524-3366
Fax Number	:	918-524-3399

Provider Business Practice Location Address
First Line	:	5555 E 71ST ST
Second Line	:	SUITE 9210
City	:	TULSA
State	:	OK
Zip	:	74136-6542
Country	:	US
Telephone Number	:	918-524-3366
Fax Number	:	918-524-3399

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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