Provider Demographics
NPI:1346355815
Name:AGIN, KERRI-RAE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KERRI-RAE
Middle Name:
Last Name:AGIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OAK GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-2608
Mailing Address - Country:US
Mailing Address - Phone:401-354-8336
Mailing Address - Fax:
Practice Address - Street 1:1413 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-1510
Practice Address - Country:US
Practice Address - Phone:401-769-0500
Practice Address - Fax:401-769-0502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI25631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice