Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS028449L | PA |
NPI | 1073673539 |
---|---|
Provider Name | Dr. Brian C Kerr |
First Address | Scranton, PA 18503-1921 |
Second Address | Scranton, PA 18503-1921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |