Healthcare Provider Details

I. General information

NPI: 1689719288
Provider Name (Legal Business Name): JOHN D KERNAN DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 W CUTHBERT BLVD
WESTMONT NJ
08108-3642
US

IV. Provider business mailing address

658 W CUTHBERT BLVD
WESTMONT NJ
08108-3642
US

V. Phone/Fax

Practice location:
  • Phone: 856-869-8660
  • Fax: 856-869-8686
Mailing address:
  • Phone: 856-869-8660
  • Fax: 856-869-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01100200
License Number StateNJ

VIII. Authorized Official

Name: MR. PETER UBER BURTON
Title or Position: CONTROLLER SECRETARY
Credential:
Phone: 856-869-8660