Provider Demographics
NPI:1992040018
Name:JOSEPH KERWIN DDS PC
Entity type:Organization
Organization Name:JOSEPH KERWIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-732-6911
Mailing Address - Street 1:1307 WASHINGTON ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-1001
Mailing Address - Country:US
Mailing Address - Phone:815-732-6911
Mailing Address - Fax:815-732-7852
Practice Address - Street 1:1307 WASHINGTON ST
Practice Address - Street 2:SUITE 130
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1001
Practice Address - Country:US
Practice Address - Phone:815-732-6911
Practice Address - Fax:815-732-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019016964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty