Provider Demographics
NPI:1851638563
Name:WAKEFIELD, KERI ROCHELLE (DDS)
Entity type:Individual
Prefix:MS
First Name:KERI
Middle Name:ROCHELLE
Last Name:WAKEFIELD
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 1:115 JEFFERSON HWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093
Mailing Address - Country:US
Mailing Address - Phone:540-967-9401
Mailing Address - Fax:540-967-9405
Practice Address - Street 1:115 JEFFERSON HWY
Practice Address - Street 2:SUITE 9
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093
Practice Address - Country:US
Practice Address - Phone:540-967-9401
Practice Address - Fax:540-967-9405
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414753122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist