Provider Demographics
NPI:1326037524
Name:KERR, DOUGLAS G (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:G
Last Name:KERR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12164 W FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-2746
Mailing Address - Country:US
Mailing Address - Phone:623-221-2573
Mailing Address - Fax:
Practice Address - Street 1:3345 E BELL RD
Practice Address - Street 2:STE 1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:65254
Practice Address - Country:US
Practice Address - Phone:480-607-3600
Practice Address - Fax:480-998-9289
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD63321223P0221X
MO20001654431223P0221X
IL90253761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ909997Medicaid