Provider Demographics
NPI:1114019007
Name:GERFEN, KEMI AMOS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEMI
Middle Name:AMOS
Last Name:GERFEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:OLUKEMI
Other - Middle Name:ADEDOYIN
Other - Last Name:AMOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 3797
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06813
Mailing Address - Country:US
Mailing Address - Phone:203-743-1972
Mailing Address - Fax:203-748-2175
Practice Address - Street 1:8 MILL PLAIN ROAD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06813
Practice Address - Country:US
Practice Address - Phone:203-743-1972
Practice Address - Fax:203-748-2175
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
108422OtherDELTA
020008422CT03OtherBLUE CROSS BLUE SHIELD