MEDICARE: MRS. NAZLI KERI 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	1223P0221X	Pediatric Dentistry	242542	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	330890986	OTHER	CA	DDS

General Provider Information

NPI Number	:	1730251851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NAZLI KERI D.D.S.

Provider Business Mailing Address
First Line	:	2226 OTAY LAKES RD STE A
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1000
Country	:	US
Telephone Number	:	619-216-7336
Fax Number	:	619-216-2084

Provider Business Practice Location Address
First Line	:	2226 OTAY LAKES RD STE A
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1000
Country	:	US
Telephone Number	:	619-216-7336
Fax Number	:	619-216-2084

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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