Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 11140 | GA |
NPI | 1043354368 |
---|---|
Provider Name | Dr. Martin E Kersh |
First Address | Lawrenceville, GA 30045-4313 |
Second Address | Lawrenceville, GA 30045-4313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 07/06/2010 |