Provider Demographics
NPI:1285865196
Name:KERBS, JILL W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:W
Last Name:KERBS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-1252
Mailing Address - Country:US
Mailing Address - Phone:419-522-3522
Mailing Address - Fax:
Practice Address - Street 1:61 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1252
Practice Address - Country:US
Practice Address - Phone:419-522-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-018171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist