MEDICARE: DR. JOHN R KEARNS D.D.S.

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	1223G0001X	General Practice Dentistry	6678	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	19006	OTHER	IA	BCBS PROVIDER NUMBER
3	6678	OTHER	IA	DELTA DENTAL PROVIDER NUM

General Provider Information

NPI Number	:	1669546669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN R KEARNS D.D.S.

Provider Business Mailing Address
First Line	:	5328 GLEN OAKS WAY
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6668
Country	:	US
Telephone Number	:	515-287-2493
Fax Number	:

Provider Business Practice Location Address
First Line	:	4551 FLEUR DR
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-2331
Country	:	US
Telephone Number	:	515-287-2493
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/09/2007

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