MEDICARE: KRISTINA KEROLUS 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	1223P0221X	Pediatric Dentistry	22DI02959300	NJ

General Provider Information

NPI Number	:	1730824129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA KEROLUS DDS

Provider Business Mailing Address
First Line	:	110 BENNINGTON DR
Second Line	:
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-5345
Country	:	US
Telephone Number	:	718-757-1196
Fax Number	:

Provider Business Practice Location Address
First Line	:	2064 W COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2014
Country	:	US
Telephone Number	:	732-637-9805
Fax Number	:

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

Provider Enumeration Date	:	05/01/2022
Last Update Date	:	07/01/2025

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