Healthcare Provider Details

I. General information

NPI: 1548295744
Provider Name (Legal Business Name): GERALD NEIL KERR, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NMCSD
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

10970 PATINA CT
SAN DIEGO CA
92131-2644
US

V. Phone/Fax

Practice location:
  • Phone: 619-524-4010
  • Fax: 619-524-5470
Mailing address:
  • Phone: 858-586-1253
  • Fax: 619-524-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberD8215
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number26441
License Number StateCA

VIII. Authorized Official

Name: DR. GERALD NEIL KERR
Title or Position: STAFF DENTIST
Credential: DDS
Phone: 619-556-8085