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General NPI Number Information
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NPI Number | 1083709232
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Entity Type | Individual
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Provider Name | MATTHEW BROOKS KERNER D.M.D
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 803 PENNSYLVANIA AVE STE 302
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City | CHARLESTON
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State | WV
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Zip | 25302
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Country | US
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Telephone | 304-388-2950
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Fax | 304-388-2951
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Provider Business Mailing Address
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Address Line | 200 MORRIS ST #107
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City | CHARLESTON
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State | WV
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Zip | 25301-1821
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Country | US
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Telephone | 304-344-2220
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Fax | 304-388-2951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0160002193
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License Number State | VT
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