Provider Demographics
NPI:1124264023
Name:KERN, JOSEPH FREDERICK (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FREDERICK
Last Name:KERN
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CASCADES CT
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1276
Mailing Address - Country:US
Mailing Address - Phone:610-828-9688
Mailing Address - Fax:
Practice Address - Street 1:26 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3201
Practice Address - Country:US
Practice Address - Phone:610-527-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0379041223S0112X
PAMT191779204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA233998Q7QMedicare PIN