Healthcare Provider Details

I. General information

NPI: 1790877405
Provider Name (Legal Business Name): CAROLYN SHULMAN KERR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NW 76TH DR
GAINESVILLE FL
32607-1593
US

IV. Provider business mailing address

340 NW 76TH DR
GAINESVILLE FL
32607-1593
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3113
  • Fax:
Mailing address:
  • Phone: 352-331-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN12069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: