Provider Demographics
NPI:1528253374
Name:KERN, AUDREY SARAH (DMD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:SARAH
Last Name:KERN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-5037
Mailing Address - Country:US
Mailing Address - Phone:508-651-1880
Mailing Address - Fax:508-650-5350
Practice Address - Street 1:35 MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-5037
Practice Address - Country:US
Practice Address - Phone:508-651-1880
Practice Address - Fax:508-650-5350
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA130311223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics