Provider Demographics
NPI:1033672720
Name:KERI ESC DENTAL GROUP APC
Entity Type:Organization
Organization Name:KERI ESC DENTAL GROUP APC
Other - Org Name:KERI ESC DENTAL GROUP APC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZLI
Authorized Official - Middle Name:
Authorized Official - Last Name:KERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-636-2665
Mailing Address - Street 1:9737 AERO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 W VALLEY PKWY STE A
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2635
Practice Address - Country:US
Practice Address - Phone:760-336-9478
Practice Address - Fax:619-362-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty