Provider Demographics
NPI:1154324689
Name:KERN, ROBERT J (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:KERN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2310 HOLMES ST
Mailing Address - Street 2:STE 800
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2602
Mailing Address - Country:US
Mailing Address - Phone:816-218-2523
Mailing Address - Fax:816-285-6923
Practice Address - Street 1:4437 S RIVER BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4658
Practice Address - Country:US
Practice Address - Phone:816-373-0800
Practice Address - Fax:816-373-0806
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2016-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20010192491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX07519Medicare UPIN
MOU60745Medicare UPIN