MEDICARE: STEPHANIE S. KERR CDA

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	126800000X	Dental Assistant	225901	OH

General Provider Information

NPI Number	:	1528415437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE S. KERR CDA

Provider Business Mailing Address
First Line	:	4055 FAR HILLS AVE
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-2440
Country	:	US
Telephone Number	:	937-299-3691
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 FAR HILLS AVE
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-2440
Country	:	US
Telephone Number	:	937-299-3691
Fax Number	:

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

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	05/20/2016

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