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General NPI Number Information
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NPI Number | 1730641937
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Entity Type | Individual
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Provider Name | JEFFREY KERST DDS
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Gender | Male
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 8789 LINE AVE
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City | SHREVEPORT
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State | LA
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Zip | 71106-6813
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Country | US
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Telephone | 318-865-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 8789 LINE AVE
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City | SHREVEPORT
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State | LA
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Zip | 71106-6813
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Country | US
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Telephone | 318-865-1600
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Fax |
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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 | 6988
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License Number State | LA
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