Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901009627 | MI |
NPI | 1003978362 |
---|---|
Provider Name | Dr. John S Kerns |
First Address | Traverse City, MI 49686 |
Second Address | Traverse City, MI 49686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |