Provider Demographics
NPI:1265642904
Name:KERWIN, JOSEPH HUNT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HUNT
Last Name:KERWIN
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 1:2587 S MUMFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-3615
Mailing Address - Country:US
Mailing Address - Phone:417-889-2108
Mailing Address - Fax:417-889-6014
Practice Address - Street 1:1530 EAST PRIMROSE
Practice Address - Street 2:SUITE D
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7910
Practice Address - Country:US
Practice Address - Phone:417-882-6606
Practice Address - Fax:417-889-6014
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0140981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice