Healthcare Provider Details

I. General information

NPI: 1053660829
Provider Name (Legal Business Name): ROBERTA ELLEN KERR DMD, MPH, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9280 E RAINTREE DR STE 108
SCOTTSDALE AZ
85260-7309
US

IV. Provider business mailing address

2555 N MARTIN LUTHER KING DR
MILWAUKEE WI
53212-2709
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-9080
  • Fax:
Mailing address:
  • Phone: 414-372-8080
  • Fax: 414-372-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9648
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: