Provider Demographics
NPI:1114046745
Name:SCHERER, KEVIN J (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:SCHERER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MAIN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2947
Mailing Address - Country:US
Mailing Address - Phone:631-751-2255
Mailing Address - Fax:631-751-7936
Practice Address - Street 1:175 MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2947
Practice Address - Country:US
Practice Address - Phone:631-751-2255
Practice Address - Fax:631-751-7936
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0399781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice