Healthcare Provider Details

I. General information

NPI: 1619069861
Provider Name (Legal Business Name): JACOB A KERST D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S CHENEY SPOKANE RD STE B
SPOKANE WA
99224-5196
US

IV. Provider business mailing address

4100 S CHENEY SPOKANE RD STE B
SPOKANE WA
99224-5196
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-5001
  • Fax: 509-919-3537
Mailing address:
  • Phone: 509-455-5001
  • Fax: 509-919-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7451
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: