Provider Demographics
NPI:1164964169
Name:KERI IRVING DMD LLC
Entity Type:Organization
Organization Name:KERI IRVING DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-270-2373
Mailing Address - Street 1:615 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3117
Mailing Address - Country:US
Mailing Address - Phone:856-853-6444
Mailing Address - Fax:856-853-1062
Practice Address - Street 1:615 SALEM AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3117
Practice Address - Country:US
Practice Address - Phone:856-853-6444
Practice Address - Fax:856-853-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022192041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty