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General NPI Number Information
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NPI Number | 1891030730
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Entity Type | Organization
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Legal Business Name | KERI D.D.S A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 2226 OTAY LAKES RD STE A
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City | CHULA VISTA
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State | CA
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Zip | 91915-1010
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Country | US
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Telephone | 619-216-7336
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Fax | 619-216-2084
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Provider Business Mailing Address
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Address Line | 2226 OTAY LAKES RD STE A
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City | CHULA VISTA
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State | CA
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Zip | 91915-1010
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Country | US
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Telephone | 619-216-7336
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Fax | 619-216-2084
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Authorized Official
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Title or Position | OWNER
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Name | NAZLI KERI
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Credential | DDS
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Telephone | 619-216-7336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 42542
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License Number State | CA
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