Healthcare Provider Details

I. General information

NPI: 1811526015
Provider Name (Legal Business Name): KERI ANN KILGORE PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 E LINCOLN HWY STE 110
COATESVILLE PA
19320-3590
US

IV. Provider business mailing address

1614-G ESKHELMAN MILL ROAD
WILLOW STREET PA
17584
US

V. Phone/Fax

Practice location:
  • Phone: 610-380-4660
  • Fax: 610-380-4664
Mailing address:
  • Phone: 717-644-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH012387L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: