Healthcare Provider Details

I. General information

NPI: 1144392515
Provider Name (Legal Business Name): MARK A KERR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S HIGLEY RD STE 116
GILBERT AZ
85296-4789
US

IV. Provider business mailing address

1355 S HIGLEY RD STE 116
GILBERT AZ
85296-4789
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-4120
  • Fax: 480-545-4123
Mailing address:
  • Phone: 480-545-4120
  • Fax: 480-545-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number5356
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5356
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5356
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: