Provider Demographics
NPI:1316984644
Name:KERRE, RICHARD LEELAND (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEELAND
Last Name:KERRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 LEXINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2404
Mailing Address - Country:US
Mailing Address - Phone:248-288-9106
Mailing Address - Fax:
Practice Address - Street 1:1101 W HURON ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3736
Practice Address - Country:US
Practice Address - Phone:248-681-8100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11581122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist