Provider Demographics
NPI:1841711579
Name:ABBOTT, KERI ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:ANNE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4766
Mailing Address - Country:US
Mailing Address - Phone:602-610-0571
Mailing Address - Fax:
Practice Address - Street 1:4235 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4766
Practice Address - Country:US
Practice Address - Phone:602-610-0571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS80621223G0001X
IL019031469122300000X
AZD011039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice