MEDICARE: DR. DANIEL DOUGLAS KERSTEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	D11792	MN
2	1223E0200X	Endodontics	1460	AK
3	1223G0001X	General Practice Dentistry	D11792	MN
4	1223E0200X	Endodontics	DEN.00203973	CO

General Provider Information

NPI Number	:	1174531818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL DOUGLAS KERSTEN DDS

Provider Business Mailing Address
First Line	:	1720 JET STREAM DR STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3938
Country	:	US
Telephone Number	:	719-488-2188
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 JET STREAM DR STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3938
Country	:	US
Telephone Number	:	719-488-2188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/22/2023

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