Healthcare Provider Details

I. General information

NPI: 1184611030
Provider Name (Legal Business Name): KERRI FONT DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15435 GLENEAGLE DR STE 200
COLORADO SPRINGS CO
80921
US

IV. Provider business mailing address

15435 GLENEAGLE DR STE 200
COLORADO SPRINGS CO
80921
US

V. Phone/Fax

Practice location:
  • Phone: 719-481-6788
  • Fax: 719-488-6585
Mailing address:
  • Phone: 719-481-6788
  • Fax: 719-488-6585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number21192
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number9990
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: